Mortality in Severe Traumatic Brain Injury: A Multivariated Analysis of 748 Brazilian Patients From Florianópolis City

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Abstract

Background:

Traumatic brain injury (TBI) is a major cause of incapacity and mortality worldwide, with most of the burden occurring in low-income and middle-income countries. A number of clinical, demographic, and neurosurgical variables of patients with TBI were associated with their outcome.

Methods:

We investigated the mortality of Brazilian patients with severe TBI at the time of discharge, using a multiple logistic regression analysis. Clinical, demographic, radiologic, and neurosurgical variables, and mortality at time of discharge of all consecutive patients (n = 748) with severe TBI (admission Glasgow scale ≤8) treated in our intensive care unit were analyzed. The variables were collected in a prospective manner between January 1994 and December 2003.

Results:

Eighty-four percent (n = 631) of the patients were men. The mean age was 34.8 (±16.3) years and the mortality was 33.3%. After the multiple logistic regression, the adjusted odds ratio (OR) for death was higher in older (>60 years) than younger (up to 30 years) patients (OR = 2.51, 95% confidence interval [CI] 1.31–4.79, p = 0.006). The mortality was also associated with sub-arachnoid hemorrhage (OR = 1.86, 95% CI = 1.23–2.81, p = 0.003) on computed tomography (CT) scan; admission Glasgow Scale of 3 or 4 in comparison to 7 or 8 (OR = 3.97, 95% CI = 2.49– 6.31, p < 0.001); bilateral midryasis (OR = 11.52, 95% CI = 5.56–23.87, p < 0.0001), or anisocoria (OR = 2.65, 95% CI = 1.69–4.17, p < 0.0001) in comparison to isocoric pupils. There was a trend for higher mortality in patients with type III injury on the Marshall classification of CT (OR = 3.63, 95% CI = 0.84–15.76, p = 0.08) than in patients with normal CT. Patients without thoracic trauma disclose higher mortality than patients with associated thoracic trauma do (OR = 2.02, 95% CI = 1.19–3.41, p = 0.009). The final model presented disclosed 76.9% of overall correct prediction with the survival and death predicted at 87.6% and 55.6%, respectively.

Conclusion:

Age, CT findings, Glasgow coma scale, pupil examination, and the presence of thoracic trauma at admission were independently associated with mortality at the time of discharge in Brazilian patients with severe TBI.

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