Risk factors for mortality in head-injured patients with probability of survival greater than 0.5.

BACKGROUND

Traumatic brain injury is one of the major problems and leading cause of death worldwide. The present study was aimed to identify factors responsible for mortality by comparing survivors and nonsurvivors in patients that had a low probability of mortality.

MATERIAL AND METHOD: A nested case-control study was conducted at Sawanpracharak Hospital from January 1, 2007 to December 31, 2007. All head injury deaths that had TRISS-PS greater than 0.5 were enrolled as the "case" patients. Head injured patients with TRISS-PS greater than 0.5 and that survived were chosen as the "control" patients. The number of controls per case was 2:1. Patients with ages < 15 were excluded from the present study.

RESULTS

Six factors associated with increased mortality are age > or = 45 years (OR = 1.61, 95% CI = 1.1-2.3), alcohol intoxication (OR = 3.11, 95% CI = 1.4-6.9), admission GCS 3-8 (OR = 4.16, 95% CI = 2.4-7.2), arrival GCS-M < or = 4 (OR = 1.46, 95% CI = 1.0-2.0), Head-AIS > or = 4 (OR = 3.31, 95% CI = 1.3-8.3), and admission SBP < 90 mmHg (OR = 13.36, 95% CI = 3.2-56.3).

CONCLUSION

Head injury continues to be a substantial public health problem. Deaths that met criteria for low probability of mortality, especially in those without associated risk factors should be analyzed for errors that may be preventable.