Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases.
BACKGROUND
This study aimed to determine predictive factors of mortality after posttraumatic brain injury.


METHODS
A retrospective study conducted over a 3-year period (1997-1999) involved 437 adult patients with head injury admitted to the intensive care unit of a university hospital in Sfax, Tunisia. Basic demographic, clinical, biologic, and radiologic data were recorded at admission and during the intensive care unit stay.


RESULTS
This study included 393 men (90%) and 44 women with a mean age of 36 +/- 17 years. Traffic accidents were the main cause of trauma (85.6%). In 58% of the cases, the injury was serious (Glasgow Coma Score, <8). The mean simplified acute physiology score was 39 +/- 15, and the mean Injury Severity Score was 34.5 +/- 17. Of the 437 patients, 127 (29.1%) died. According to multivariate analysis, the factors that correlated with a poor prognosis were age older than 40 years (p < 0.01), simplified acute physiology score exceeding 40 (p < 0.001), Glasgow Coma Score lower than 7 (p = 0.03), intracranial mass lesion (p = 0.02), a cerebral herniation (p < 0.001), diabetes insipidus (p < 0.001), and blood sugar level higher than 10 mmol/L (p < 0. 001).


CONCLUSIONS
In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised.
Bahloul
Mabrouk
M
Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia. bahloulmab@yahoo.fr
Chelly
Hedi
H
Ben Hmida
Mohamed
M
Ben Hamida
Chokri
C
Ksibi
Hichem
H
Kallel
Hatem
H
Chaari
Adel
A
Kassis
Mondher
M
Rekik
Noureddine
N
Bouaziz
Mounir
M
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014416:Tunisia / Q000453:epidemiology