Factors influencing the outcomes of patients with severe traumatic brain injury following road traffic crashes

Abstract

Background: Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity in South Africa. Road traffic crashes (RTCs) are among the commonest aetiology of TBI in South Africa. This study aimed to determine the factors influencing the outcomes in patients with severe TBI following RTCs. Methods: A retrospective study was conducted of patients who were admitted to the neurosurgery department at Inkosi Albert Luthuli Central Hospital between January 2013 and December 2017 with TBI following RTCs and with a Glasgow Coma Scale (GCS) < 9. Demographic, clinical, and radiological information was obtained. The outcome at discharge was categorised into favourable and unfavourable, using the Glasgow outcome score. Statistical analysis was performed to determine factors contributing to the outcome. Results: The study population consisted of 100 patients. The mean age was 29.5 ± 14.1 years old (range 3–81 years). The majority of patients (85%) were males. Pedestrian vehicle accidents accounted for 46%, compared to motor vehicle collisions (54%). The mean hospital stay duration was 14.2 ± 8.8 days (range 1–43 days). The median post-resuscitation GCS was 6 (range 3–8), (p = 0.52). Fifty-two patients had an unfavourable outcome compared to 48 who had a favourable outcome. Eleven patients presented with pupillary abnormalities (p = 0.88), which included unilateral dilated non-reactive (DNR) pupil in seven patients, whilst four patients had bilateral. Five patients developed refractory intracranial hypertension (RIC-HTN), all these patients had unfavourable outcomes, (p = 0.03). Thirty-eight patients developed systemic hypotension (SBP < 90 mmHg), 32 out of these patients had unfavourable outcomes (p < 0.001). In female patients, 80% had unfavourable outcomes compared to 47% of male patients (p = 0.02). Extracranial injuries were diagnosed in 50 patients, and 24 patients had unfavourable outcomes (p = 0.42). Conclusion: The outcomes in patients with severe TBI following road traffic crashes are influenced by hypotension (SBP < 90 mmHg), RIC-HTN and female gender, which have a negative influence on outcomes.