International Classification of Diseases-Based Audit of the Injury Database to Understand the Injury Distribution in Patients Who have Sustained a Head Injury (International Classification of Diseases Codes: S00-S09)

Abstract

Background: Traumatic brain injury (TBI) is the leading cause of mortality, morbidity, and disability globally. Methods for a reliable prediction of outcomes on the admission of TBI cases are of great clinical relevance to stakeholders.

Objectives: This study used the International Classification of Diseases-10 codes (S00-S09) for analysis of injury distribution of TBI patients and attempted to find the prognostic predictors of Glasgow coma scale (GCS) in the outcome from readily accessible parameters.

Methods: The data were reanalyzed from the Towards Improved Trauma Care Outcomes (TITCO) project from India. TITCO is the prospective, observational, multicenter trauma registry, contained data of trauma patients admitted to four public university hospitals in Mumbai, Delhi, and Kolkata collected from October 2013 to September 2015.

Results: Among 8525 cases under study, low GCS scores before admission, which was dependent on the demographic variables and related risk factors occurring at the time of injury, were important in the prognostic predictors of mortality. However, survival probability during hospitalization remained uniformly uncertain for the elderly. Death as outcome of injury was dependent on the average intensity of injury, GCS on admission, critical injury severity score, and intubation within 1 h of admission and between 1 and 24 h of admission. These factors emerged as the independent predictors of fatality. The time of the day of injury did not yield any significant association with low GCS or demise in our study.

Conclusions: GCS <8, i.e., severe at the time of admission, was an unfavorable predictor of in-hospital mortality.

Keywords: Glasgow coma scale; injury severity score; outcome assessment; traumatic brain injury.