World Journal of Surgery

, Volume 42, Issue 5, pp 1346–1357 | Cite as

Predictors and Time-Based Hospital Mortality in Patients with Isolated and Polytrauma Brain Injuries

  • Ayman El-Menyar
  • Rafael Consunji
  • Husham Abdelrahman
  • Rifat Latifi
  • Bianca M. Wahlen
  • Hassan Al-Thani
Original Scientific Report
  • 112 Downloads

Abstract

Background

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. We studied the predictors and time-based mortality in patients with isolated and polytrauma brain injuries in a rapidly developing country. We hypothesized that TBI-related 30-day mortality is decreasing over time.

Methods

A retrospective analysis was conducted for all patients with moderate-to-severe TBI who were admitted directly to a level 1 trauma center between 2010 and 2014. Patient’s data were analyzed and compared according to survival (survived vs. not survived), time (early death [2 days], intermediate [3–7 days] versus late [>7 days]) post-injury, and type (polytrauma vs. isolated TBI). Cox proportional hazards models were performed for the predictors of mortality.

Results

A total of 810 patients were admitted with moderate-to-severe TBI with a median age of 27 years. Traffic-related injury was the main mechanism of TBI (65%). Isolated TBIs represented 22.6% of cases and 56% had head AIS >3. The overall mortality rate was 27%, and most of deaths occurred in the intermediate (40%) and early period (38%). The incidence of TBI was greater in patients aged 21–30 years but the mortality was proportionately higher among elderly. The average annual incidence was 8.43 per 100,000 population with an overall mortality of 2.28 per 100,000 population. Kaplan–Meier curves showed that polytrauma had greater mortality than isolated TBI. However, Cox survival analysis showed that age [Hazard ratio (HR) 1.02], scene GCS (HR 0.86),subarachnoid hemorrhage (HR 1.7), and blood transfusion amount (HR 1.03) were the predictors of mortality regardless of being polytrauma or isolated TBI after controlling for 14 relevant covariates.

Conclusions

The 30-day survival in patients with TBI is improving over the years in Qatar; however, the mortality remains high in the elderly males. The majority of deaths occurred within a week after the injury. Further studies are needed to assess the long-term survival in patients with moderate-to-severe TBI.

Notes

Acknowledgements

The authors thank the entire registry database team, trauma research office, injury prevention program in the section of trauma surgery for their contribution and continuous support. Data supporting the present findings can be obtained, if needed, after getting permission from the medical research center (MRC) at HMC (research@hamad.qa).

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Authors' contributions

Authors have contributed to AE acquisition of data conception and design of the study, interpretation of data, writing manuscript, and critical review of manuscript; RC acquisition of data conception and design of the study, interpretation of data, writing manuscript, and critical review of manuscript; RL design of the study, interpretation of data, writing manuscript, and critical review of manuscript; HAR acquisition of data conception and design of the study, interpretation of data, writing manuscript, and critical review of manuscript; BW interpretation of data, writing manuscript, and critical review of manuscript; HAL study design, acquisition of data, and critical review of manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Roozenbeek B, Maas AI, Menon DK (2013) Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 9:231–236CrossRefPubMedGoogle Scholar
  2. 2.
    El-Menyar A, Mekkodathil A, Al-Thani H, Consunji R, Latifi R (2017) Incidence, demographics and outcome of traumatic brain injury in the middle east: a systematic review. World Neurosurg. pii: S1878-8750(17)31170-1Google Scholar
  3. 3.
    Tabish SA, Syed N (2015) Recent advances and future trends in traumatic brain injury. Emerg Med (Los Angel) 5:229. doi: 10.4172/2165-7548.1000229 Google Scholar
  4. 4.
    Scholten AC, Haagsma JA, Panneman MJ, van Beeck EF, Polinder S (2014) Traumatic brain injury in the Netherlands: incidence, costs and disability-adjusted life years. PLoS ONE 9(10):e110905. doi: 10.1371/journal.pone.0110905 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC (2007) The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation 22:341–353PubMedGoogle Scholar
  6. 6.
    Faul M, Xu L, Wald MM, Coronado VG (2010) Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, AtlantaGoogle Scholar
  7. 7.
    Al-Habib A, A-Shail A, Alaqeel A, Zamakhshary M, Al-Bedah K, Alqunai M, Al-Enazi S (2013) Causes and patterns of adult traumatic head injuries in Saudi Arabia: implications for injury prevention. Ann Saudi Med 33(4):351–355. doi: 10.5144/0256-4947.2013.351 CrossRefPubMedGoogle Scholar
  8. 8.
    Tuma MA, Acerra JR, El-Menyar A, Al-Thani H, Al-Hassani A, Recicar JF, Al Yazeedi W, Maull KI (2013) Epidemiology of workplace-related fall from height and cost of trauma care in Qatar. Int J Crit Illn Inj Sci 3(1):3–7. doi: 10.4103/2229-5151.109408 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Latifi R, El-Menyar A, Al-Thani H, Zarour A, Parchani A, Abdulrahman H, Asim M, Peralta R, Consunji R (2015) Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme. Int J Inj Contr Saf Promot 22(2):136–142. doi: 10.1080/17457300.2013.857693 CrossRefPubMedGoogle Scholar
  10. 10.
    Consunji RJ, Peralta RR, Al-Thani H, Latifi R (2015) The implications of the relative risk for road mortality on road safety programmes in Qatar. Inj Prev 21(e1):e105–e108. doi: 10.1136/injuryprev-2013-040939 CrossRefPubMedGoogle Scholar
  11. 11.
    Abdelrahman H, El-Menyar A, Al-Thani H, Consunji R, Zarour A, Peralta R, Parchani A, Latifi R (2014) Time-based trauma-related mortality patterns in a newly created trauma system. World J Surg 38(11):2804–2812. doi: 10.1007/s00268-014-2705-x CrossRefPubMedGoogle Scholar
  12. 12.
    Bener A, Omar AO, Ahmad AE, Al-Mulla FH, Abdul Rahman YS (2010) The pattern of traumatic brain injuries: a country undergoing rapid development. Brain Inj 24:74–80CrossRefPubMedGoogle Scholar
  13. 13.
    El-Matbouly M, El-Menyar A, Al-Thani H, Tuma M, El-Hennawy H, AbdulRahman H et al (2013) Traumatic brain injury in Qatar: age matters–insights from a 4-year observational study. Sci World J. doi: 10.1155/2013/354920 (eCollection 2013) Google Scholar
  14. 14.
    Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, Murray GD, Maas AI (2003) Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 99(4):666–673CrossRefPubMedGoogle Scholar
  15. 15.
    Savitsky B, Givon A, Rozenfeld M, Radomislensky I, Peleg K (2016) Traumatic brain injury: it is all about definition. Brain Inj 30(10):1194–1200CrossRefPubMedGoogle Scholar
  16. 16.
    Langlois JA, Rutland-Brown W, Wald MM (2006) The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21:375–378CrossRefPubMedGoogle Scholar
  17. 17.
    Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J (2006) A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 148(3):255–268 (discussion 268) CrossRefGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention (2015) Report to Congress on traumatic brain injury in the United States: epidemiology and rehabilitation. National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, AtlantaGoogle Scholar
  19. 19.
    Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V, Dessalles PH, Cazaugade M, Labadens P, Aquitaine Group for Severe Brain Injuries Study (2001) Epidemiology of severe brain injuries: a prospective population-based study. J Trauma 51(3):481–489PubMedGoogle Scholar
  20. 20.
    Andelic N, Anke A, Skandsen T, Sigurdardottir S, Sandhaug M, Ader T, Roe C (2012) Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality in Norway: a national cohort study. Neuroepidemiology 38(4):259–267. doi: 10.1159/000338032 CrossRefPubMedGoogle Scholar
  21. 21.
    Namjoshi DR, Good C, Cheng WH, Panenka W, Richards D, Cripton PA, Wellington CL (2013) Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective. Dis Model Mech 6(6):1325–1338. doi: 10.1242/dmm.011320 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AI (2015) Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien) 157(10):1683–1696. doi: 10.1007/s00701-015-2512-7 CrossRefGoogle Scholar
  23. 23.
    Xing Wu et al (2008) Epidemiology of traumatic brain injury in eastern China, 2004: a prospective large case study. J Trauma 64:1313–1319CrossRefGoogle Scholar
  24. 24.
    Li M, Zhao Z, Yu G, Zhang J (2016) Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol Neurosci 1(2):1007Google Scholar
  25. 25.
    Shivaji T, Lee A, Dougall N, McMillan T, Stark C (2014) The epidemiology of hospital treated traumatic brain injury in Scotland. BMC Neurol 6(14):2. doi: 10.1186/1471-2377-14-2 CrossRefGoogle Scholar
  26. 26.
    Kuenzler M, Braun CT, Maeder MB (2015) Mortality and outcome of severe traumatic brain injury in a Swiss level one trauma center. Emerg Med (Los Angel) 5:1. doi: 10.4172/2165-7548.1000226 Google Scholar
  27. 27.
    Al-Kuwaiti A, Hefny AF, Bellou A, Eid HO, Abu-Zidan FM (2012) Epidemiology of head injury in the United Arab Emirates. Ulus Travma Acil Cerrahi Derg 18(3):213–218. doi: 10.5505/tjtes.2012.03710 CrossRefPubMedGoogle Scholar
  28. 28.
    Maas AI, Stocchetti N, Bullock R (2008) Moderate and severe traumatic brain injury in adults. Lancet Neurol 7(8):728–741. doi: 10.1016/S1474-4422(08)70164-9 CrossRefPubMedGoogle Scholar
  29. 29.
    Vigu´e B, Ract C, Tazarourte K (2012) The first 24 hours after severe head trauma. In: Vincent JL (ed) Annual update in intensive care and emergency medicine 2012, pp 722–728, XVIII. http://www.springer.com/978-3-642-25715-5

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Clinical Research, Trauma Surgery SectionHamad General HospitalDohaQatar
  2. 2.Department of Clinical MedicineWeill Cornell Medical CollegeDohaQatar
  3. 3.Department of Surgery, Trauma Surgery SectionHamad General HospitalDohaQatar
  4. 4.Department of SurgeryWestchester Medical CenterValhallaUSA
  5. 5.Department of Anesthesia, Trauma SurgeryHamad General HospitalDohaQatar

Personalised recommendations