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

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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.

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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.

Author information

Authors and Affiliations

  1. Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar

    Ayman El-Menyar

  2. Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

    Ayman El-Menyar

  3. Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar

    Rafael Consunji, Husham Abdelrahman & Hassan Al-Thani

  4. Department of Surgery, Westchester Medical Center, Valhalla, NY, USA

    Rifat Latifi

  5. Department of Anesthesia, Trauma Surgery, Hamad General Hospital, Doha, Qatar

    Bianca M. Wahlen

Authors
  1. Ayman El-Menyar
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  2. Rafael Consunji
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  3. Husham Abdelrahman
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  4. Rifat Latifi
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  5. Bianca M. Wahlen
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  6. Hassan Al-Thani
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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.

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Correspondence to Ayman El-Menyar.

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El-Menyar, A., Consunji, R., Abdelrahman, H. et al. Predictors and Time-Based Hospital Mortality in Patients with Isolated and Polytrauma Brain Injuries. World J Surg 42, 1346–1357 (2018). https://doi.org/10.1007/s00268-017-4310-2

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  • DOI: https://doi.org/10.1007/s00268-017-4310-2

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