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. 2023 Mar 8;23(1):101.
doi: 10.1186/s12883-023-03145-2.

Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital - a cohort study

Álvaro Réa-Neto  1   2 , Elizeu Daniel da Silva Júnior  3 , Gabriela Hassler  3 , Valkiria Backes Dos Santos  4 , Rafaella Stradiotto Bernardelli  4   5 , Amanda Christina Kozesinski-Nakatani  4   6 , Marcelo José Martins-Junior  4 , Fernanda Baeumle Reese  4   7 , Mariana Bruinje Cosentino  4   7 , Mirella Cristine Oliveira  4   7 , Hélio Afonso Ghizoni Teive  8
Affiliations

Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital - a cohort study

Álvaro Réa-Neto et al. BMC Neurol. .

Abstract

Background: Traumatic brain injury (TBI) has substantial physical, psychological, social and economic impacts, with high rates of morbidity and mortality. Considering its high incidence, the aim of this study was to identify epidemiological and clinical characteristics that predict mortality in patients hospitalized for TBI in intensive care units (ICUs).

Methods: A retrospective cohort study was carried out with patients over 18 years old with TBI admitted to an ICU of a Brazilian trauma referral hospital between January 2012 and August 2019. TBI was compared with other traumas in terms of clinical characteristics of ICU admission and outcome. Univariate and multivariate analyses were used to estimate the odds ratio for mortality.

Results: Of the 4816 patients included, 1114 had TBI, with a predominance of males (85.1%). Compared with patients with other traumas, patients with TBI had a lower mean age (45.3 ± 19.1 versus 57.1 ± 24.1 years, p < 0.001), higher median APACHE II (19 versus 15, p < 0.001) and SOFA (6 versus 3, p < 0.001) scores, lower median Glasgow Coma Scale (GCS) score (10 versus 15, p < 0.001), higher median length of stay (7 days versus 4 days, p < 0.001) and higher mortality (27.6% versus 13.3%, p < 0.001). In the multivariate analysis, the predictors of mortality were older age (OR: 1.008 [1.002-1.015], p = 0.016), higher APACHE II score (OR: 1.180 [1.155-1.204], p < 0.001), lower GCS score for the first 24 h (OR: 0.730 [0.700-0.760], p < 0.001), greater number of brain injuries and presence of associated chest trauma (OR: 1.727 [1.192-2.501], p < 0.001).

Conclusion: Patients admitted to the ICU for TBI were younger and had worse prognostic scores, longer hospital stays and higher mortality than those admitted to the ICU for other traumas. The independent predictors of mortality were older age, high APACHE II score, low GCS score, number of brain injuries and association with chest trauma.

Keywords: Craniocerebral trauma; Intensive care unit; Trauma; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Process of selection of the study sample Abbreviations: ICU, intensive care unit; TBI, traumatic brain injury
Fig. 2
Fig. 2
Annual incidence and mortality rate for TBI in ICU. A: Annual incidence of ICU admissions due to TBI among traumatic reasons. B: Mortality rate for TBI victims admitted to the ICU per year Abbreviations: ICU, intensive care unit; TBI, traumatic brain injury
See this image and copyright information in PMC

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