Clinical characteristics and prognosis of traumatic head injury following road traffic accidents admitted in ICU “analysis of 694 cases”

  • Hedi Chelly
  • Mabrouk BahloulEmail author
  • Rania Ammar
  • Ahmed Dhouib
  • Khaireddine Ben Mahfoudh
  • Mohamed Zaher Boudawara
  • Olfa Chakroun
  • Imen Chabchoub
  • Anis Chaari
  • Mounir Bouaziz
Original Article



The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis.


A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay.


There were 592 males (85.3%), and 102 female patients. The mean age was at 31.8 ± 17.8 years (range 1–91). The mechanism of the accident was detailed in 666 patients (96%). The majority of the victims were motorcycle riders and/or passengers (40.5%), followed by pedestrians (29.1%). Extra-cranial pathology was present in 452 patients (65%). A total of 677 patients (97.6%) required intubation, mechanical ventilation, and sedation. Mean ICU stay was 16 ± 17.4 days. A total of 187 patients (26.9%) died during their hospital stay. The GOS performed within a mean delay of 6 months after hospital discharge was as follows: 198 deaths (28.5%), 13 vegetative state (1.9%), and 349 (50.3%) good recovery and/or moderate disability. A multivariate analysis showed that the factors which correlated with a poor prognosis (mortality and severe disability) were: age > 38 years, Glasgow coma scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic).


In Tunisia, traumatic brain injury due to RTAs is a frequent cause of ICU admission, especially among young adults, and is associated with high mortality and morbidity rates. The majority of the victims were motorcycle riders and/or passengers and pedestrians. The factors associated with a poor outcome were: age > 38 years, Glasgow Coma Scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). As a consequence, prevention is highly warranted.


Trauma Head injury Road traffic accident Intensive care unit Multivariate analysis Prognosis 



Traumatic brain injury


Intensive Care Unit


Road traffic accidents


Computed cerebral tomography


Glasgow coma scale score


Simplified acute physiology score


Pediatric risk of mortality


Pediatric trauma score (PTS)


Diffuse axonal injury


Intracranial pressure


Secondary systemic insults


Glasgow outcome scale


Subdural hematoma



All authors thank Professor Chokri Khalaf for his help in the redaction of this manuscript.

Author contributions

All authors contributed to study conception and design, data analysis, and drafting the manuscript. HC and MB contributed to data analysis and statistical analysis. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Availability of data and materials

The data sets were analyzed during the current study available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The study was approved by an Internal Review Board.


This study received no funding.

Consent for publication

Not applicable.


  1. 1.
    Chelly H, Chaari A, Daoud E, Dammak H, Medhioub F, Mnif J, Hamida CB, Bahloul M, Bouaziz M. Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma. 2011;71:838 – 46.CrossRefPubMedGoogle Scholar
  2. 2.
    Bahloul M, Chelly H, Ben Hmida M, Ben Hamida C, Ksibi H, Kallel H, Chaari A, Kassis M, Rekik N, Bouaziz M. Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma. 2004;57:255 – 61.CrossRefPubMedGoogle Scholar
  3. 3.
    Castello FV, Cassano A, Gregory P, et al. The pediatric risk of mortality (PRISM) score and injury severity score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma. Crit Care Med. 1999;27:985–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Chesnut RM, Marshall LF, Klauber MR, et al (1993). The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 34: 216 – 22.Google Scholar
  5. 5.
    Bahloul M, Ben Hamida C, Chelly H, Chaari A, Kallel H, Dammak H, Rekik N, Bahloul K, Ben Mahfoudh K, Hachicha M, Bouaziz M. (2009). Severe head injury among children: prognostic factors and outcome. Injury. 40(5):535–540.CrossRefPubMedGoogle Scholar
  6. 6.
    Bahloul M, Chelly H, Chaari A, Chabchoub I, Haddar S, Herguefi L, Dammak H, Hamida CB, Ksibi H, Kallel H, Rekik N, Bouaziz M. Isolated traumatic head injury in children: Analysis of 276 observations. J Emerg Trauma Shock. 2011;4(1):29–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Garner JS, Jarvis WR, Emori TG, et al (1988). CDC definitions for nosocomial infections. Am J Infect Control. 16:128–140.CrossRefPubMedGoogle Scholar
  8. 8.
    Granry JC, Dubé L, Terminassian A, Frebet E, Le Rolle T. Multimodal monitoring of head injuries in children. Ann Fr Anesth Reanim. 2002;21:148–156.CrossRefPubMedGoogle Scholar
  9. 9.
    Greger NG, Kirkland RT, Clayton GW, et al. Central diabetes insipidus. 22 years’ experience (1986). Am J Dis Child. 140: 551–4.Google Scholar
  10. 10.
    Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Bahloul M, Chaari A, Chabchoub I, Medhyoub F, Dammak H, Kallel H, Ksibi H, Haddar S, Rekik N, Chelly H, Bouaziz M. Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations. J Emerg Trauma Shock. 2011;4:198–206.CrossRefPubMedGoogle Scholar
  12. 12.
    Melo JR, Di Rocco F, Blanot S, Laurent-Vannier A, Reis RC, Baugnon T, Sainte-Rose C, et al. Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury. Acta Neurochir (Wien). 2010;152:1559–65.CrossRefGoogle Scholar
  13. 13.
    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Jackisch J, Sethi D, Mitis F, Szymañski T, Arra I. European facts and the Global status report on road safety. 2015 (WHO 2015).Google Scholar
  15. 15.
    Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AI. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015;157(10):1683–96.CrossRefGoogle Scholar
  16. 16.
    Deepika A, Devi BI, Shukla D. Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury. Neurol India. 2017;65:83–6.PubMedGoogle Scholar
  17. 17.
    Benham EC, Ross SW, Mavilia M, Fischer PE, Christmas AB, Sing RF. Injuries from all-terrain vehicles: an opportunity for injury prevention. Am J Surg. 2016. Scholar
  18. 18.
    Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, Peeters W, Feigin V, Theadom A, Holkovic L, Synnot A. Epidemiology of traumatic brain injury in europe: a living systematic review. J Neurotrauma. 2016. Scholar
  19. 19.
    Rondina C, Videtta W, Petroni G, Lujan S, Schoon P, Mori LB, Matkovich J, Carney N, Chesnut R. Mortality and morbidity from moderate to severe traumatic brain injury in Argentina. J Head Trauma Rehabil. 2005;20:368–76.CrossRefPubMedGoogle Scholar
  20. 20.
    Herou E, Romner B, Tomasevic G. Acute traumatic brain injury: mortality in the elderly. World Neurosurg. 2015;83:996–1001.CrossRefPubMedGoogle Scholar
  21. 21.
    Gerber LM, Chiu YL, Carney N, Härtl R, Ghajar J. Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg. 2013;119:1583–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Dhandapani S, Manju D, Sharma B, Mahapatra A. Prognostic significance of age in traumatic brain injury. J Neurosci Rural Pract. 2012;3:131–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Salottolo K, Carrick M, Stewart Levy A, Morgan BC, Slone DS, Bar-Or D. The epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3. J Crit Care. 2016;38:197–201.CrossRefPubMedGoogle Scholar
  24. 24.
    Maas AI1, Steyerberg EW, Butcher I, Dammers R, Lu J, Marmarou A, Mushkudiani NA, McHugh GS, Murray GD. Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:303–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Yokobori S, Nakae R, Yokota H, Spurlock MS, Mondello S, Gajavelli S, Bullock RM. Subdural hematoma decompression model: A model of traumatic brain injury with ischemic-reperfusional pathophysiology: A review of the literature. Behav Brain Res doi. 2016. Scholar
  26. 26.
    Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015;15:220. Scholar
  27. 27.
    Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, et al. Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg. 1982;56:26–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Lee JJ, Segar DJ, Morrison JF, Mangham WM, Lee S, Asaad WF. Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury. J Neurosurg. 2017. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Hedi Chelly
    • 1
  • Mabrouk Bahloul
    • 1
    Email author
  • Rania Ammar
    • 1
  • Ahmed Dhouib
    • 1
  • Khaireddine Ben Mahfoudh
    • 2
  • Mohamed Zaher Boudawara
    • 3
  • Olfa Chakroun
    • 4
  • Imen Chabchoub
    • 5
  • Anis Chaari
    • 1
  • Mounir Bouaziz
    • 1
  1. 1.Department of Intensive CareHabib Bourguiba University HospitalSfaxTunisia
  2. 2.Department of RadiologyHabib Bourguiba University HospitalSfaxTunisia
  3. 3.Department of NeurosurgeryHabib Bourguiba University HospitalSfaxTunisia
  4. 4.Departement of Emergency MedicineHabib Bourguiba University HospitalSfaxTunisia
  5. 5.Department of PediatricsHedi Chaker University HospitalSfaxTunisia

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