Long-Term Mortality and Quality of Life Among Adults With Mild Traumatic Brain Injury.

IMPORTANCE

Mild traumatic brain injuries (mTBIs) are the most common form of TBI and are responsible for 1.37 million years lived with disability annually, disproportionately affecting low- and middle-income countries (LMICs), as 90% of TBIs occur in LMICs.

OBJECTIVE

To measure the long-term mortality (12 months), quality of life (QoL), and functional status of patients with mTBI in Pakistan.

DESIGN, SETTING, AND

PARTICIPANTS

This cohort study was an analysis of prospectively collected data of patients with mTBI from a trauma registry of all injured patients from 2 tertiary care centers in Karachi, Pakistan, from December 2021 to May 2024, who were followed up for 12 months. Participants were adult patients (aged >18 years) admitted with mTBI and enrolled in the registry with recorded outcomes at 1, 3, 6, and 12 months.

EXPOSURE: Mild TBI (Glasgow Coma Scale [GCS] score of 13-15).

MAIN OUTCOMES AND MEASURES: Long-term mortality (12-month cumulative and follow-up) was the primary outcome, and QoL was the secondary outcome.

RESULTS

A total of 602 patients presented with mTBI. Most were aged 18 to 39 years (336 patients [55.8%]), were male (502 patients [83.4%]), and experienced mTBIs from road traffic collisions (427 patients [71.1%]), or falls (130 patients [21.6%]). Surgical interventions were performed in 176 cases (29.2%) and were associated with 51% lower odds of 1-month cumulative mortality (adjusted hazard ratio, 0.44; 95% CI, 0.21-0.87). The inpatient, cumulative 1-month, and 12-month mortality rates were 4.6%, 8.9%, and 13.6%, respectively. Patients with a GCS score of 13 (20.2%) and 14 (20.1%) had a higher 12-month mortality rate as compared with patients with a GCS score of 15 (8.3%). Of 345 patients with follow-up data at 1 year, 269 (78.0%) achieved complete independence by 1 year. The functional engagement domain showed the highest rate of recovery (318 patients [92.2%]), while the physical well-being and recovery domain had the lowest, with 286 (82.9%) experiencing disability, particularly those with a GCS score of 13 and 14; only 59 (17.1%) reported no physical disability at 12 months.

CONCLUSION AND RELEVANCE: In this cohort study of patients with mTBI in Pakistan, 12-month mortality was approximately 2-fold higher in patients with a GCS score of 13 to 14 (20.2% and 20.1%) compared with a GCS score of 15 (8.3%), alongside persistently poorer quality of life in lower-GCS score groups throughout the recovery period.