Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City.
BACKGROUND
Traumatic brain injury (TBI) is a major cause of incapacity and mortality worldwide, with most of the burden occurring in low-income and middle-income countries. A number of clinical, demographic, and neurosurgical variables of patients with TBI were associated with their outcome.


METHODS
We investigated the mortality of Brazilian patients with severe TBI at the time of discharge, using a multiple logistic regression analysis. Clinical, demographic, radiologic, and neurosurgical variables, and mortality at time of discharge of all consecutive patients (n = 748) with severe TBI (admission Glasgow scale < or = 8) treated in our intensive care unit were analyzed. The variables were collected in a prospective manner between January 1994 and December 2003.


RESULTS
Eighty-four percent (n = 631) of the patients were men. The mean age was 34.8 (+/-16.3) years and the mortality was 33.3%. After the multiple logistic regression, the adjusted odds ratio (OR) for death was higher in older (> 60 years) than younger (up to 30 years) patients (OR = 2.51, 95% confidence interval [CI] 1.31-4.79, p = 0.006). The mortality was also associated with sub-arachnoid hemorrhage (OR = 1.86, 95% CI = 1.23-2.81, p = 0.003) on computed tomography (CT) scan; admission Glasgow Scale of 3 or 4 in comparison to 7 or 8 (OR = 3.97, 95% CI = 2.49- 6.31, p < 0.001); bilateral midryasis (OR = 11.52, 95% CI = 5.56-23.87, p < 0.0001), or anisocoria (OR = 2.65, 95% CI = 1.69-4.17, p < 0.0001) in comparison to isocoric pupils. There was a trend for higher mortality in patients with type III injury on the Marshall classification of CT (OR = 3.63, 95% CI = 0.84-15.76, p = 0.08) than in patients with normal CT. Patients without thoracic trauma disclose higher mortality than patients with associated thoracic trauma do (OR = 2.02, 95% CI = 1.19-3.41, p = 0.009). The final model presented disclosed 76.9% of overall correct prediction with the survival and death predicted at 87.6% and 55.6%, respectively.


CONCLUSIONS
Age, CT findings, Glasgow coma scale, pupil examination, and the presence of thoracic trauma at admission were independently associated with mortality at the time of discharge in Brazilian patients with severe TBI.
Martins
Evandro Tostes
ET
Unidade de Terapia Intensiva, Hospital Governador Celso Ramos, Florianópolis, SC, Brasil.
Linhares
Marcelo Neves
MN
Sousa
Daniel Santos
DS
Schroeder
Humberto Kruger
HK
Meinerz
Jardel
J
Rigo
Luís Antônio
LA
Bertotti
Melina Moré
MM
Gullo
Jackson
J
Hohl
Alexandre
A
Dal-Pizzol
Felipe
F
Walz
Roger
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001938:Brazil / Q000453:epidemiology; D002648:Child; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D014505:Urban Population; D055815:Young Adult