Traumatic Brain Injury: in-hospital Survival Rates and the Main Predictors of in-hospital Mortality in Northeastern Brazil*

Abstract

Background Upper middle-income countries have epidemiological peculiarities that should be considered to identify the main predictive factors of intrahospital mortality regarding traumatic brain injury (TBI) to address modifiable problems.

Objective To assess the in-hospital survival of patients with TBI and to identify the predictors of in-hospital death.

Methods This is a retrospective dynamic cohort study of victims of TBI who were admitted to the Hospital de Urgência de Sergipe (HUSE, in the Portuguese acronym) between March 1, 2017 and April 29, 2018. The outcome considered was in-hospital death from any cause. Cox regression was used to assess predictors of in-hospital mortality.

Results The sample comprised 596 patients, with a median age of 31.0 (12–94) years old, 504 (84%) of whom were men. Regarding TBI severity, 250 had mild TBI; 121 had moderate TBI; and 225 had severe TBI. The average follow-up was 20.6 ± 4.0 days, with 60 in-hospital deaths and a 30-day mortality of 22.9%. Four independent predictors of in-hospital death were identified: acute subdural hemorrhage (ASDH) (risk ratio [RR] = 1.926; 95% confidence interval [CI] = 1.15–3.22; p = 0.013), swelling (risk ratio [RR] = 3.706; 95%CI = 2.21–6.19; p < 0.001), skull fracture (RR = 2.551; 95%CI = 1.36–4.75; p = 0.003), and severe TBI (RR = 2.039; 95%CI = 1.29–4.12; p = 0.005).

Conclusions Acute subdural hemorrhage, swelling, skull cap fracture, and a Glasgow Coma Scale score of < 9 at admission were independent predictors of in-hospital mortality in patients with TBI.

Resumo

Introdução Os países de renda média alta possuem peculiaridades epidemiológicas que devem ser levadas em consideração para identificar os principais fatores preditivos de mortalidade intrahospitalar por traumatismo cranioencefálico (TCE) a fim de abordar problemas modificáveis.

Objetivo Avaliar a sobrevida hospitalar de pacientes com TCE e identificar os preditores de óbito hospitalar.

Métodos Trata-se de um estudo de coorte dinâmico retrospectivo de vítimas de TCE que deram entrada no Hospital de Urgência de Sergipe (HUSE) entre 1° de março de 2017 e 29 de abril de 2018. O desfecho considerado foi óbito hospitalar por qualquer causa. A regressão de Cox foi usada para avaliar os preditores de mortalidade hospitalar.

Resultados A amostra foi composta por 596 pacientes, com idade mediana de 31,0 (12–94) anos, sendo 504 (84%) homens. Em relação à gravidade do TCE, 250 tiveram TCE leve; 121 tiveram TCE moderado, e 225 tiveram TCE grave. O seguimento médio foi de 20,6 ± 4,0 dias, com 60 óbitos hospitalares e mortalidade em 30 dias de 22,9%. Quatro preditores independentes de morte hospitalar foram identificados: hemorragia subdural aguda (ASDH, na sigla em inglês) (risk ratio [RR] = 1,926; intervalo de confiança [IC] 95% = 1,15–3,22; p = 0,013), inchaço (RR = 3,706; IC95% = 2,21–6,19; p < 0,001), fratura de crânio (RR = 2,551; IC95% = 1,36–4,75; p = 0,003) e TCE grave (RR = 2,039, IC95% = 1,29–4,12; p = 0,005).

Conclusões Hemorragia subdural aguda, edema, fratura da calota craniana e pontuação na Escala de Coma de Glasgow < 9 na admissão foram preditores independentes de mortalidade hospitalar em pacientes com TCE.

Keywords

developing country - mortality - survival - traumatic brain injury

Palavras-chave

país em desenvolvimento - mortalidade - sobrevivência - traumatismo cranioencefálico

^* Hospital de Urgência de Sergipe, Aracaju, SE, Brazil

Publication History

Received: 03 February 2022

Accepted: 21 June 2023

Article published online:
31 October 2023

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