Survival status, mortality predictors, and scores in patients with severe traumatic brain injury in the intensive care unit.

BACKGROUND

Patients with traumatic brain injury (TBI) occupy an important place in intensive care units (ICUs) with high morbidity and mortality rates. The aim of this study was to determine the parameters predictive of mortality as the primary outcome and the distribution of these parameters as a secondary outcome in patients admitted to the ICU with TBI.

METHODS

After ethics committee approval and informed consent of the patient's relatives, TBI patients over 18 years of age treated in the anesthesia and reanimation ICU of our hospital between 2021 and 2023 were retrospectively included in our cohort study. The association and distribution of 18 different parameters, including demographic and clinical characteristics of TBI patients at ICU admission, with mortality were compared. Univariate and multivariate analyses were used to estimate the odds ratio for mortality.

RESULTS

Of the 194 patients included in the study, 80.4% were male, the mean age was 39.1±19.8 years, and the mortality rate was 35,1%. When comparing patients in 2 groups as survivor and non-survivor, patients in non-survivor group had a significantly lower mean Glasgow Coma Scale (GCS) score (5.7±3.1 vs. 10.1±3.1, p<0.001), revised trauma score (RTS) (5.25±2.1 vs. 10.6±2.7), the rate of surgery (33.8% vs. 53.2%, p<0.01), and the rate of epidural hematoma (EDH) (33.8% vs. 53.2%, p<0.01). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (29 vs. 13, p<0.001), the estimated mortality rate based on the mean APACHE II score (55% vs. 12%, p<0.001), the stress index (SI), (62.3±29.5 vs. 42.4±19.2, p<0.001), the rate of intracerebral hematoma/hemorrhage (ICH) (52.9% vs. 30.2%, p<0.01), the rate of skull fracture (80.9% vs. 24.6%, p<0.01), and the rate of intubation (94.1% vs. 60.3%, p<0.01) were found to be higher in non-survivor group. In multivariate analysis, the significant independent predictors of mortality were high APACHE II score (OR: 1.292 [1.192-1.400, p<0.001]), high SI (OR: 0.820 [0.699-0.921], p<0.001), and the presence of concomitant skull fracture (OR: 4.982 [1.894-13.103], p<0.001).

CONCLUSION

our study, high APACHE II score, high SI, presence of skull fracture, low GCS score, low RTS, intubation, and presence of ICH were associated with high mortality, while operability and presence of EDH were associated with low mortality. Therefore, we believe that these parameters should be prioritized when following TBH cases to initiate treatment earlier and prevent high mortality.