Outcome of severe traumatic brain injury at a critical care unit: a review of 87 patients

Abstract

OBJECTIVE: To determine the outcome of severe traumatic brain injury and to document the factors influencing mortality.DESIGN: A six months prospective study. SETTINGS: The intensive care unit (ICU) of Kenyatta National Hospital (KNH), a tertiary referral centre in Kenya.SUBJECTS: Eighty Seven adult patients with severe traumatic brain injury admitted between April and September 2005.METHODS: Basic demographic, clinical, radiological and mechanism of injury data were recorded at admission and during ICU stay. The main outcome measure was survival or death.The outcome groups were compared for the injury severity, mean arterial pressure, serum glucose level, grade of diffuse axonal injury and the presence of mydriasis and anisocoriausing the X2 test and the Fischers Exact test as appropriate.RESULTS: Severe traumatic brain injury accounted for 14.3% of all ICU admissions. This study included 73 men (83.9%) and 14women (16.1%) with a mean patient age of 34 ± 17 years. Motor vehicle accidents were the main cause (58.6%). Forty six patients (54.0%) died. Twenty nine percent of patients hadpersistent vegetative state or severe disability. Factors that were associated with poor outcome on univariate analysis were Glasgow coma scale of less than 5, diffuse axonal injury andintracerebral mass lesions and blood sugar greater than 10mmol / L.CONCLUSION: Severe TBI is a frequent cause of hospital admission to critical care units among young men with a high mortality (54%) rate.