Abstract
Introduction: Traumatic brain injury is a disease with high mortality rates, so it is highly relevant to identify the factors that affect it.
Materials and methods: An analytical study was prepared between 2020 and 2021, which included patients with moderate and severe head trauma, characterized the variables most related to prognosis, such as demographic, clinical, and radiological aspects, and analyzed the association between mortality and these variables.
Results: Hospital mortality was 22.8%, finding as conditions related to mortality the respiratory rate, anisocoria, pupillary reflex, ICU care and as a factor related to survival, the number of days of hospital stay.Discussion: Mortality due to traumatic brain injury is higher in low- and middle-income countries, possibly due to a higher incidence of traffic accidents and limited access to treatment. The factors identified in this study are consistent with previous research, emphasizing the importance of pupillary abnormalities in patient assessment.
Conclusions: A comprehensive physical examination from the time of admission is crucial, as the presence of tachypnea, anisocoria, absence of pupillary reflex, or signs of shock can dictate prognosis. While global literature primarily focuses on characterizing traumatic brain injuries, this study underscores the need for further research on factors predicting protracted hospital courses with fatal outcomes.
References
Thurman D, Kraus JF, Romer C. Standards for surveillance of neurotrauma. Ginebra, Suiza: World Health Organization; 1995.
Knuth T, Letarte PB, Ling G, Moores LE, Rhee P, Tauber D, et al. Guidelines for the field management of combat-related head trauma. Nueva York, Estados Unidos: Brain Trauma Foundation; 2005.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet. 1974;304(7872):81-4. https://doi.org/10.1016/S0140-6736(74)91639-0
National Center for Injury Prevention and Control. Report to congress on mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Atlanta: Centers for Disease Control and Prevention; 2003.
Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923-29. https://doi.org/10.1016/S0140-6736(00)02689-1
Najem D, Rennie K, Ribecco-Lutkiewicz M, Ly D, Haukenfrers J, Liu Q, et al. Traumatic brain injury: classification, models, and markers. Biochem Cell Biol. 2018;96(4):391-406. https://doi.org/10.1139/bcb-2016-0160
Herrera MMP, Ariza HAG, Rodríguez CJJ, Pacheco HA. Epidemiología del trauma craneoencefálico. Rev Cub Med Int Emerg. 2018;17(supl. 2):3-6.
Shaikh F, Munakomi S, Waseem M. Head trauma. En: StatPearls [Internet]. Treasure Island, Florida, Estados Unidos: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK430854/
Bonow RH, Barber J, Temkin NR, Videtta W, Rondina C, Petroni G, et al. The outcome of severe traumatic brain injury in Latin America. World Neurosurg. 2018;111:e82-90. https://doi.org/10.1016/j.wneu.2017.11.171
Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213-38. https://doi.org/10.1016/j.mcna.2019.11.001
Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. J Neurol. 2019;266(11):2878-89. https://doi.org/10.1007/s00415-019-09541-4
Frey C, Hazenfield JM. Essentials of head trauma imaging. Semin Ultrasound CT MRI. 2018;39(5):469-80. https://doi.org/10.1053/j.sult.2018.01.004
Mollayeva T, Mollayeva S, Colantonio A. Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nat Rev Neurol. 2018;14(12):711-22. https://doi.org/10.1038/s41582-018-0091-y
Wang KK, Yang Z, Zhu T, Shi Y, Rubenstein R, Tyndall JA, et al. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn. 2018;18(2):165-80. https://doi.org/10.1080/14737159.2018.1428089
Robinson CP. Moderate and severe traumatic brain injury. Continuum. 2021;27(5):1278-300. https://doi.org/10.1212/CON.0000000000001036
Dang B, Chen W, He W, Chen G. Rehabilitation treatment and progress of traumatic brain injury dysfunction. Neural Plast. 2017;2017:1582182. https://doi.org/10.1155/2017/1582182
Godoy DA, Rabinstein AA. How to manage traumatic brain injury without invasive monitoring? Curr Opin Crit Care. 2022;28(2):111-22. https://doi.org/10.1097/MCC.0000000000000914
Castellanos-Acuña AJ, Leal-Cantú R, Andrade-Chávez VR, González-García CL. Incidencia de muerte encefálica en pacientes con traumatismo craneoencefálico grave: Estudio en el Hospital General “Dr. Miguel Silva”. Rev Mex Neuroci. 2015;16(5):29-38.
Centers for Disease Control and Prevention. Report to congress on traumatic brain injury in the United States: Epidemiology and rehabilitation. Atlanta, Estados Unidos: National Center for Injury Prevention and Control; 2015.
Eaton J, Hanif AB, Grudziak J, Charles A. Epidemiology, Management, and Functional Outcomes of Traumatic Brain Injury in Sub-Saharan Africa. World Neurosurg. 2017;108:650-5. https://doi.org/10.1016/j.wneu.2017.09.084
Tran TM, Fuller AT, Kiryabwire J, Mukasa J, Muhumuza M, Ssenyojo H, et al. Distribution and characteristics of severe traumatic brain injury at Mulago National Referral Hospital in Uganda. World Neurosurg. 2015;83(3):269-77. https://doi.org/10.1016/j.wneu.2014.12.028
Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019;130(4):1080-97. https://doi.org/10.3171/2017.10.JNS17352
De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG, Fernandes J, et al. Patient outcome after traumatic brain injury in high-, middle-, and low-income countries: analysis of data on 8927 patients in 46 countries. Int J Epidemiol. 2009;38(2):452-8. https://doi.org/10.1093/ije/dyn189
MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336(7641):425-9. https://doi.org/10.1136/bmj.39461.643438.25
Staton CA, Msilanga D, Kiwango G, Vissoci JR, de Andrade L, Lester R, et al. A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward. Int J Inj Contr Saf Promot. 2017;24(1):69-77. https://doi.org/10.1080/17457300.2015.1061562
Ó Briain D, Nickson C, Pilcher DV, Udy AA. Early hyperoxia in patients with traumatic brain injury admitted to intensive care in Australia and New Zealand: a retrospective multicenter cohort study. Neurocrit Care. 2018;29(3):443-51. https://doi.org/10.1007/s12028-018-0553-5
Shiraishi A, Otomo Y, Yoshikawa S, Morishita K, Roberts I, Matsui H. Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score. Crit Care. 2019;23(1):365. https://doi.org/10.1186/s13054-019-2636-x
Vieira de Oliveira D, de Cássia Almeida Vieira R, Zumerkorn Pipek L, Cardoso de Sousa RM, de Souza CPE, Santana-Santos E, et al. Long-term outcomes in severe traumatic brain injury and associated factors: a prospective cohort study. J Clin Med. 2022;11(21):6466. https://doi.org/10.3390/jcm11216466
Sagar D, Dahlstrom JJ, Weisbrod LJ. Neurogenic Shock. En: StatPearls [Internet]. Treasure Island, Florida, Estados Unidos: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK459361/
Jin G, deMoya MA, Duggan M, Knightly T, Mejaddam AY, Hwabejire J, et al. Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock. 2012;38(1):49-56. https://doi.org/10.1097/SHK.0b013e3182574778
Chico-Fernández M, Barea-Mendoza JA, Pérez-Bárcena J, García-Sáez I, Quintana-Díaz M, Marina L, et al. Concomitant traumatic brain injury and hemorrhagic shock: outcomes using the spanish trauma icu registry (RETRAUCI). Am Surg. 2021;87(3):370-5. https://doi.org/10.1177/0003134820949990
Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10). https://doi.org/10.3310/hta17100
Cardozo Júnior LC, da Silva RR. Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality. Rev Bras Ter Intensiva. 2014;26(2):148-154. https://doi.org/10.5935/0103-507X.20140022
Woischneck D, Schmitz B, Kapapa T. MRI detection of cerebral lesions in post-traumatic anisocoria: specificity and prognostic significance. Clin Radiol. 2017;72(5):426.e7-15. https://doi.org/10.1016/j.crad.2016.11.011
Assamadi M, Benantar L, Ait El Qadi A, Abou El Hassan T, Aniba K. Aspects épidémiologiques et facteurs pronostiques des traumatisés crâniens graves [Epidemiological aspects and prognostic factors of severe traumatic brain injuries]. Neurochirurgie. 2021;67(6):571-8. https://doi.org/10.1016/j.neuchi.2021.04.005
Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, et al. Mortality-associated characteristics of patients with traumatic brain injury at the University Teaching Hospital of Kigali, Rwanda. World Neurosurg. 2017;102:571-82. https://doi.org/10.1016/j.wneu.2017.03.001
Global Forum for Health Research. The 10/90 Report on Health Research: 2003-2004. Ginebra, Suiza: Global Forum for Health Research; 2004

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

