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Our aim was to clarify the magnitude of this burden and its modifiers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:bold>Material and methods<\/jats:bold>\n                    <\/jats:title>\n                    <jats:p>A random-effects meta-analysis of longitudinal observational studies published through July 2025 was performed. PubMed\/Medline, Cochrane Library, Google Scholar, PEDro, and EMBASE were searched for studies reporting standardized mortality ratios or life-expectancy data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall pooled standardized mortality ratio was 3.19 (95% CI 2.59\u20133.92; I\u00b2 = 67.4%), estimated by restricted maximum likelihood with Hartung\u2013Knapp adjustment. Analyses stratified by data-collection era demonstrated a progressive decline in relative mortality from 3.95 (1974\u20131987) to 2.18 (2004\u20132019;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Injury-severity gradients based on Glasgow Coma Scale yielded ratios of 4.51, 2.84, and 1.67 for severe, moderate, and mild injuries, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Age-specific analyses in contemporary cohorts showed the highest relative risk in middle-aged survivors (SMR 7.18 for ages 35\u201354) and lower ratios in older groups (SMR 2.41 for \u2265\u200975 years). Mortality peaked within two years post-injury (SMR 6.34) but remained elevated beyond ten years (SMR 2.87). Meta-regression identified study era, follow-up duration, mean age, proportion of severe cases, and sample size as key modifiers, explaining 84.7% of between-study variance. Weighted mean life-expectancy reduction across eight cohorts was 7.6 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings quantify long-term survival burden after TBI and support the development of comprehensive, lifelong management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-025-08706-6","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:42:54Z","timestamp":1775781774000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe traumatic brain injury and long-term survival: a meta-analysis on life expectancy and mortality trends"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6000-7042","authenticated-orcid":false,"given":"Donatella","family":"Saviola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0299-215X","authenticated-orcid":false,"given":"Stefania","family":"Bruni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Bonavita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Zadra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Ciavarella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Cannav\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4803-419X","authenticated-orcid":false,"given":"Antonio","family":"De Tanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"11","key":"8706_CR1","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/S1474-4422(22)00309-X","volume":"21","author":"AI Maas","year":"2022","unstructured":"Maas AI, Menon DK, Manley GT, Abrams M, \u00c5kerlund C, Andelic N et al (2022) Traumatic brain injury: progress and challenges in prevention, clinical care, and research. 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