Factors Affecting Mortality After Severe Traumatic Brain Injury in a Multidisciplinary Tertiary Hospital

Abstract

Background: Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality. It can result from various causes, including traffic accidents, particularly motorcycle accidents, which are common in Taiwan; falls on stairs or from buildings; and sports or leisure activities. This study investigated the factors contributing to mortality after TBI in a multidisciplinary tertiary hospital.

Methods: A retrospective study was conducted from January 2020 to December 2022 at E-DA Hospital, Kaohsiung city, Taiwan. Severe TBI was defined as a Glasgow coma scale score < 9. The data collection followed the guidelines of the disease-specific care certification program of the Joint Commission of Taiwan. The study excluded patients younger than 20 years. Data on relevant factors were collected, including APACHE II scores, age, causes of TBI, body mass index (BMI), duration of mechanical ventilation, hospital length of stay, and the results of disengagement. The data were analyzed using an independent sample t-test and logistic regression.

Results: The study included a total of 136 patients with severe TBI who were admitted to the ICU through the emergency department. All of these patients received endotracheal intubation. The average age of the patients was 53.9 years, and the mortality rate was 30.88%; n = 43). The majority of patients were male (men:women = 92:44). Mortality in the ICU was significantly associated with mean APACHE II scores (28.55; P < .001) but not with initial BMI, cause of TBI, or age. Regarding brain decompression craniectomy or craniotomy, 97 patients (71.32%) underwent the procedure, and 39 (28.68%) did not. Those who underwent decompression craniectomy or craniotomy had a longer mean duration of mechanical ventilation (11.76 vs. 6.95 days; P < .015) and length of hospital stay (29.28 vs. 15.95 days; P < .001).

Conclusions: The study explored factors associated with mortality after severe TBI. Higher APACHE II scores were correlated with higher mortality rates, as was expected. Clinical decision-making, particularly related to limiting decompression craniectomy and craniotomy, should not be based on APACHE II alone. Decisions regarding surgical interventions must be made in consideration of the difficulties of weaning patients off mechanical ventilation and the potential for prolonged mechanical ventilation and hospital stay.