Health science reports · 2026
Risk Factors for Poor Outcomes of Mild and Moderate Traumatic Brain Injury Patients in Tanzania: A Retrospective Cohort Study Using Latent Class Analysis.
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Barcenas Loren, Elahi Cyrus, Nkenguye William, Krishnamoorthy Vijay, Joseph Swapna, Sakita Francis M, Vissoci João Ricardo Nickenig, Staton Catherine
Аннотация
BACKGROUND AND AIMS: Traumatic brain injury (TBI) is a major global health concern, especially in low- and middle-income countries (LMICs). LMICs have higher injury rates and limited quality of care. TBI patients can be stratified as mild, moderate, and severe risk based on the Glasgow Coma Scale (GCS). Although most poor outcomes are from severe TBIs, mild and moderate TBI patients significantly contribute to the overall morbidity and mortality, and may benefit from early monitoring to identify deterioration of status. Our goal was to identify unique subgroups within the mild and moderate TBI population at a high risk for poor outcomes.
METHODS: We selected mild (GCS 14-15) and moderate (GCS 9-13) TBI patients from a TBI registry collected at a small city, regional referral hospital in Moshi, Tanzania, from May 2014 to April 2017. With these subsets (mild: n = 1738, moderate: n = 346), we performed a latent class analysis (LCA) to define unique patient classes based on clinical course, vital signs, and demographics. We then performed a survival analysis using a Cox proportional hazard model to examine the association of the defined latent classes with clinical outcome. The predictor variables were demographic variables, hospital interventions, and vital signs. The outcome of interest was a dichotomized discharge Glasgow outcome scale extended score (good outcome 7-8 and poor outcome 1-6).
RESULTS: The LCA identified five classes among mild TBI patients: Adolescent (18.8%), Assault (31.5%), Young Adult Polytrauma (32.7%), Adult Polytrauma (9.2%), and RTI with ICU (7.8%). Three classes were identified among moderate TBI patients: Assault (20.2%), RTI with ICU (26.3%), and RTI without ICU (53.5%). Road traffic injury was the predominant mechanism in both severity groups (67% and 68%, respectively), and poor outcomes occurred in 4% of mild and 16% of moderate TBI patients. Relative to the lowest-risk reference class, all other mild TBI classes had higher hazards of poor outcomes. Among moderate TBI classes, RTI with ICU had a higher hazard of poor outcome than RTI without ICU (HR 2.58, 95% CI 1.26-5.24).
CONCLUSION: We identified clinically distinct latent classes within GCS-defined mild and moderate TBI groups, with differences in discharge outcomes across classes. These findings suggest that combining GCS category with demographic, physiological, injury, and care-process information may provide additional prognostic stratification. The results do not establish that GCS is inadequate; rather, they support further evaluation of complementary, context-appropriate risk-stratification approaches.
METHODS: We selected mild (GCS 14-15) and moderate (GCS 9-13) TBI patients from a TBI registry collected at a small city, regional referral hospital in Moshi, Tanzania, from May 2014 to April 2017. With these subsets (mild: n = 1738, moderate: n = 346), we performed a latent class analysis (LCA) to define unique patient classes based on clinical course, vital signs, and demographics. We then performed a survival analysis using a Cox proportional hazard model to examine the association of the defined latent classes with clinical outcome. The predictor variables were demographic variables, hospital interventions, and vital signs. The outcome of interest was a dichotomized discharge Glasgow outcome scale extended score (good outcome 7-8 and poor outcome 1-6).
RESULTS: The LCA identified five classes among mild TBI patients: Adolescent (18.8%), Assault (31.5%), Young Adult Polytrauma (32.7%), Adult Polytrauma (9.2%), and RTI with ICU (7.8%). Three classes were identified among moderate TBI patients: Assault (20.2%), RTI with ICU (26.3%), and RTI without ICU (53.5%). Road traffic injury was the predominant mechanism in both severity groups (67% and 68%, respectively), and poor outcomes occurred in 4% of mild and 16% of moderate TBI patients. Relative to the lowest-risk reference class, all other mild TBI classes had higher hazards of poor outcomes. Among moderate TBI classes, RTI with ICU had a higher hazard of poor outcome than RTI without ICU (HR 2.58, 95% CI 1.26-5.24).
CONCLUSION: We identified clinically distinct latent classes within GCS-defined mild and moderate TBI groups, with differences in discharge outcomes across classes. These findings suggest that combining GCS category with demographic, physiological, injury, and care-process information may provide additional prognostic stratification. The results do not establish that GCS is inadequate; rather, they support further evaluation of complementary, context-appropriate risk-stratification approaches.