Association between Outcome of severe traumatic brain injury and demographic, clinical, injury-related variables of patients

Abstract

Background:Traumatic brain injury (TBI) is a main health problem among communities. There exists a variety of effective factors on the outcome of patients with TBI. We describe the demographic, clinical, and injury related variables of the patients with severe TBI, and determine the predictors of outcome.Materials and Methods:We did this cross-sectional study on all 267 adult patients with severe TBI admitted to three trauma centers of Isfahan University of Medical Sciences (IUMS) from March 20, 2014 to March 19, 2015. Data were extracted from patients' profiles. We considered the patients' outcome as discharged and died. We analyzed the collected data using descriptive (frequency, mean, and standard deviation) and analytical (independent t-test, Mann–Whitney U-test, Kruskal–Wallis test and logistic regression) statistics in Statistical Package for the Social Sciences (SPSS) 16.0. We considered p < 0.05 as the significance level.Results:The mean (SD) age of patients was 43.86 (18.40) years. The majority of the population was men (87.27%). Road traffic accidents (RTAs) were the most common mechanism of trauma (79.40%). The mean (SD) of Glasgow coma scale (GCS) was 6.03 (3.11). In 50.19% of the patients, the pupillary reflex was absent. One hundred and twenty-four patients (46.44%) died before discharge. We found age, gender, GCS, pupillary reflex, hypernatremia, and increased intracranial pressure (IICP) as the predictors of death in severe TBI.Conclusions:In this study, the mortality rate of patients with severe TBI was high. In addition, some factors were determined as the significant predictors of outcome. The findings can assist in planning to enhance the quality of care and reduce the mortality rate in the patients with severe TBI.

Predicting outcomes 3 months after traumatic brain injury in patients admitted to emergency department

“…(8,12,25) Interestingly, the other study conducted on TBI in Iranians reported that its subjects were 85% men and 15% women, figures that are identical to the gender ratio of our patients. (3) However, our comparison of clinical outcomes of TBI shows that gender has no effect on the incidence of death following a TBI. Considering that several other studies have reported a similar conclusion, (3,7,26) it can be claimed with sufficient confidence that gender has no impact on the outcome of TBI.…”

“…Flow diagram of traumatic brain injury similar reports in other studies suggests that age is likely to be a key factor of the clinical outcome of TBI, and younger people have a lower chance of mortality following a TBI. (3,10) It has also been reported that each year of increase in age is associated with 5% higher chance of postconcussion syndrome and 2% higher chance of a GCS of less than 7. (10,18,19) Both quantitative and qualitative analyses of our study showed that reduced GCS is another important factor in the adverse clinical outcomes of TBI.…”

“…(20,21) Although our finding in regard to the association of GCS with the clinical outcome of TBI is not new and has been previously mentioned in other studies, (9)(10)(11) this is the first prospective study that reports such an association in Iran, although a cross-sectional study in Iran found age, gender, GCS, pupillary reflex, hypernatremia, and increased intracranial pressure (IICP) as the predictors of death in severe TBI. (3) Among the vital signs, only the heart rate exhibited an association with undesirable clinical outcomes. However, this association was only observed in quantitative analyses (there was no relationship between tachycardia and outcome in the qualitative analysis).…”

“…(2) In Iran, trauma, and especially TBI, is one of the leading causes of death following a hospital admission. (3,4) Because of its severe physiological, emotional, and physical complications, this injury imposes significant direct and indirect financial burdens that are hard to bear, especially in low-and middleincome countries, where more than 90% of TBI cases occur. (1,5) In the last decade, the hospitalization rate has shown no notable change and the mortality rate has declined, but there has been an increase in the number of TBIrelated admissions to Emergency Departments (ED).…”

“…age and gender) in different parts of the world, these models may not be uniformly applicable to all countries. (11,12) In Iran, which has a particularly high rate of traffic and occupational accidents, only one retrospective study has investigated the prognostic factors of TBI; (3) therefore, more prospective studies are needed to develop a localized model for predicting the outcomes of TBI for Iranian patients.…”