Tegegne Nega Getachew, Fentie Demeke Yilkal, Tegegne Biresaw Ayen, Admassie Belete Muluadam
Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Anesthesia, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Patient Relat Outcome Meas. 2023 Apr 5;14:73-85. doi: 10.2147/PROM.S399603. eCollection 2023.
Traumatic brain injury is a major list of health and socioeconomic problems especially in low- and middle-income countries which influences productive age groups. Differences in patient characteristics, socioeconomic status, intensive care unit admission thresholds, health-care systems, and the availability of varying numbers of intensive care unit (ICU) beds among hospitals had shown to be the causes for the variation on the incidence in mortality following traumatic brain injury across different continents. The aim of this study was to assess the incidence and predictors of mortality among patients with traumatic brain injury at University of Gondar Comprehensive Specialized Hospital.
A retrospective follow-up study was conducted based on chart review and selected patient charts admitted from January, 2017 to January, 2022. Participants in the study were chosen using a simple random sample procedure that was computer generated. Data was entered with epi-data version 4.6 and analyzed using SPSS version 26. Both bivariate and multivariate logistic regression analyses were used, and in multivariate logistic regression analysis, P-value <0.05 with 95% CI was considered statistically significant.
The magnitude of mortality was 28.8%. Most of the injuries were caused by assault followed by road traffic accident (RTA). About 30% of the subjects presented with severe head injuries and epidural hematoma (EDH) followed by skull fracture were the most common diagnoses on admission. The independent predictors of mortality were male sex (AOR: 6.12, CI: 1.82, 20.5), severe class injury with Glasco coma scale (GCS <9) (AOR: 5.96, CI: 2.07, 17.12), intraoperative hypoxia episode (AOR: 10.5, CI: 2.6-42.1), hyperthermia (AOR: 25, CI: 5.54, 115.16), lack of pre-hospital care (AOR: 2.64 CI: 1.6-4.2), abnormal appearance on both eyes (AOR: 13.4, CI: 5.1-34.6), in-hospital hypoxia episode and having extra-cranial concomitant injury were positively associated with mortality, while on admission, systolic blood pressure (SBP) of 100-149 (AOR: 0.086, CI: 0.016-0.46) was negatively associated with mortality.
The overall mortality rate was considerably high. As a result, traumatic brain injury management should be focused on modifiable factors that increase patient mortality, such as on-admission hypotension, a lack of pre-hospital care, post-operative complications, an intraoperative hypoxia episode, and hyperthermia.
创伤性脑损伤是一系列主要的健康和社会经济问题，尤其是在影响劳动年龄组的低收入和中等收入国家。患者特征、社会经济地位、重症监护病房入院阈值、医疗保健系统以及医院间不同数量的重症监护病房（ICU）床位的可用性差异已被证明是不同大陆创伤性脑损伤死亡率发生率差异的原因。本研究的目的是评估贡德尔大学综合专科医院创伤性脑损伤患者的死亡率及预测因素。
基于病历回顾进行回顾性随访研究，选取2017年1月至2022年1月入院的患者病历。研究参与者采用计算机生成的简单随机抽样程序选取。数据使用Epi-Data 4.6版本录入，并使用SPSS 26版本进行分析。采用双变量和多变量逻辑回归分析，在多变量逻辑回归分析中，P值<0.05且95%置信区间被认为具有统计学意义。
死亡率为28.8%。大多数损伤由袭击引起，其次是道路交通事故（RTA）。约30%的受试者表现为重度颅脑损伤，入院时最常见的诊断是硬膜外血肿（EDH），其次是颅骨骨折。死亡率的独立预测因素为男性（比值比[AOR]：6.12，置信区间[CI]：1.82，20.5）、格拉斯哥昏迷量表（GCS<9）的重度损伤（AOR：5.96，CI：2.07，17.12）、术中缺氧发作（AOR：10.5，CI：2.6 - 42.1）、高热（AOR：25，CI：5.54，115.16）、缺乏院前护理（AOR：2.64，CI：1.6 - 4.2）、双眼外观异常（AOR：13.4，CI：5.1 - 34.6）、院内缺氧发作和存在颅外合并伤与死亡率呈正相关，而入院时收缩压（SBP）为100 - 149（AOR：0.086，CI：0.016 - 0.46）与死亡率呈负相关。
总体死亡率相当高。因此，创伤性脑损伤的管理应关注增加患者死亡率的可改变因素，如入院时低血压、缺乏院前护理、术后并发症、术中缺氧发作和高热。
