Incidence and Predictors of Mortality Among Patients with Traumatic Brain Injury at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study

Abstract

Background

Traumatic brain injury is a major list of health and socioeconomic problems especially in low- and middle-income countries which influences productive age groups. Differences in patient characteristics, socioeconomic status, intensive care unit admission thresholds, health-care systems, and the availability of varying numbers of intensive care unit (ICU) beds among hospitals had shown to be the causes for the variation on the incidence in mortality following traumatic brain injury across different continents. The aim of this study was to assess the incidence and predictors of mortality among patients with traumatic brain injury at University of Gondar Comprehensive Specialized Hospital.

Methods

A retrospective follow-up study was conducted based on chart review and selected patient charts admitted from January, 2017 to January, 2022. Participants in the study were chosen using a simple random sample procedure that was computer generated. Data was entered with epi-data version 4.6 and analyzed using SPSS version 26. Both bivariate and multivariate logistic regression analyses were used, and in multivariate logistic regression analysis, P-value <0.05 with 95% CI was considered statistically significant.

Results

The magnitude of mortality was 28.8%. Most of the injuries were caused by assault followed by road traffic accident (RTA). About 30% of the subjects presented with severe head injuries and epidural hematoma (EDH) followed by skull fracture were the most common diagnoses on admission. The independent predictors of mortality were male sex (AOR: 6.12, CI: 1.82, 20.5), severe class injury with Glasco coma scale (GCS <9) (AOR: 5.96, CI: 2.07, 17.12), intraoperative hypoxia episode (AOR: 10.5, CI: 2.6–42.1), hyperthermia (AOR: 25, CI: 5.54, 115.16), lack of pre-hospital care (AOR: 2.64 CI: 1.6–4.2), abnormal appearance on both eyes (AOR: 13.4, CI: 5.1–34.6), in-hospital hypoxia episode and having extra-cranial concomitant injury were positively associated with mortality, while on admission, systolic blood pressure (SBP) of 100–149 (AOR: 0.086, CI: 0.016–0.46) was negatively associated with mortality.

Conclusion

The overall mortality rate was considerably high. As a result, traumatic brain injury management should be focused on modifiable factors that increase patient mortality, such as on-admission hypotension, a lack of pre-hospital care, post-operative complications, an intraoperative hypoxia episode, and hyperthermia.

Keywords:

• head injury
• mortality
• trauma
• injury

Abbreviations

ASDH, Acute Subdural Hematoma; BGL, Blood Glucose Level; CT, Computerized Tomography; EDH, Epidural Hematoma; FDI, Fall down injury; GCS, Glasgow Coma Scale/Score; ICU, Intensive Care Unit; LMIC, Low and Middle Income Country; MV, Mechanical Ventilator; PR, Pulse Rate; RR, Respiratory Rate; RTA, Road Traffic Accident; SBP, Systolic Blood Pressure; SDH, Subdural Hematoma; SpO2, Oxygen Saturation; TBI, Traumatic Brain Injury; THI, Traumatic Head Injury; UOGCSH, University of Gondar Comprehensive Specialized Hospital; WHO, World Health Organization.

Data Sharing Statement

Data for this study are available on request.

Ethical Approval

Ethical approval for this study has been received from the institutional review board of School of medicine, College of medicine and health science, University of Gondar with reference number of 1267/2022. The ethics committee approved this study to not need consent from the study participants because of the retrospective nature of data and a support letter has been obtained from the medical director office of the hospital for retrieving retrospective data from the database and records. All the information was kept confidential, and no individual identifiers were collected. We have confirmed that our study complies with the Declaration of Helsinki.

Acknowledgment

The authors thank both Debre Tabor University and University of Gondar for funding and providing necessary resources.

Author Contributions

All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed to be accountable on the journal to which the article has been submitted.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Debre Tabor University.