Current Status and Outcomes of Critical Traumatic Brain Injury (GCS=3-5) in a Developing Country: A Retrospective, Registry-Based Study

Background Patients sustaining critical TBI [initial Glasgow Coma Scale (GCS) <= 5] generally have poor outcomes. Little is known about the frequency, mortality rate, and functional outcomes of such patients in Iran. Methods In this retrospective, registry-based cohort study, the demographic and clinicoradiological findings of TBI patients were queried from March 21, 2017, to March 21, 2020. We included TBI patients with initial GCS of 3-5. The functional outcome was assessed using the Glasgow Outcome Score-extended 6 (GOSE-6) months after the hospital discharge. Patients were classified as having unfavorable (GOSE-6 <= 4) and favorable (GOSE-6 > 4) outcomes. Gathered data were compared between groups. Multivariable logistic regression analysis was done to find factors affecting the outcome. Results Four hundred ninety-seven patients (mean age = 37.59 +/- 17.89) were enrolled, and 69.2% had unfavorable outcomes. Elderly patients (age >= 65 years) were highly overrepresented among the unfavorable group. 48.9% had bilateral fixed dilated pupils (BDFP), who mostly attained unfavorable outcomes. The overall in-hospital mortality rate was 50.3%. The in-hospital mortality rate was appalling among elderly patients with BFDP and GCS 3( 90%) and GCS 4(100%). Age >= 65 years [odds ratio (OR) 3.45, 95% confidence interval (CI) 1.19-10.04], and BFDP (OR 4.48, 95% CI 2.60-7.73) increase the odds of unfavorable outcomes according to the regression analysis. Conclusion The survival rate and favorable outcomes of critical TBI patients are generally poor. However, we believe that the neurotrauma surgeons should discuss with patients' proxies and explain the clinical conditions and possible outcomes.

Automated summary

This study retrospectively analyzed the clinical conditions and functional outcomes of TBI patients in Iran, and found that critical TBI patients generally have poor survival rates and favorable outcomes. Factors such as old age and bilateral fixed dilated pupils increase the likelihood of unfavorable outcomes.