Outcome analysis and outcome predictors of severe traumatic brain injury in patients admitted to a level 1 trauma unit

Abstract

Introduction: Rapid transportation to the relevant trauma facility is crucial in the mortality and morbidity of severely injured patients. Traumatic brain injury (TBI) remains the source of international mortality and morbidity, surpassing all other trauma-related injuries. Predicting patient outcomes in TBIs involves formulating a logical association between the patient’s initial assessment and overall patient outcome. Objective: The purpose of this study was to analyse patient outcome in severe TBI according to their transportation methods to a level 1 trauma facility and the associated outcome predictors. Methods: This study was a retrospective, quantitative study based on patient outcomes and the associated outcome predictors in patients transported to Inkosi Albert Luthuli Central Hospital (IALCH) by different transport methods between January 2017 to December 2018. All patients were categorised according to age and the severity of traumatic brain injury. All patients older than 12 years of age were included in this study. Patients classified as having a severe traumatic brain injury (TBI) based on the Glasgow Coma Score (GCS) and/or CT scan findings were included in this study. Results: There were 202 patients included in the study; 167 were males. Motor vehicle collision was the most common mechanism of injury, accounting for 41.1% of patients’ injuries in the study. Mortality was significantly greater in direct admissions compared to interhospital transfers (p<0.001). Patients who were directly admitted to IALCH were admitted for a shorter length of stay compared to inter-hospital transfer. A significantly higher mortality rate in hypotensive patients on arrival at the emergency department (ED) was identified (p=0.02). This study revealed a borderline significance between hyperglycemia and mortality, suggesting that further research would be interesting (p=0.07). New injury severity score (NISS), revised trauma score (RTS) and Glasgow Coma Scale (GCS) demonstrated good predictions of mortality. However, the results of this study suggest that the new injury severity score was the most accurate predictor of outcome. Conclusion: These results suggest that assessments of physiological/anatomical scoring systems and predictors of the outcome can be a valuable component in predicting mortality in cases of severe traumatic brain injury and that the mechanism of the injury influences mortality and the length of stay.