Incidence and predictors of mortality among traumatic brain injury patients admitted to Amhara region Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022

Abstract

Introduction: Globally, traumatic brain injury is a substantial cause of mortality and morbidity across all age groups, with a disproportionately higher burden borne by low- and middle-income countries. In low-resource settings, the burden is magnified by fragmented health care systems that are often unable to deliver effectively the acute and long-term care the patients require. Besides its burden, there is little information on TBI mortality in Ethiopia, especially in the region Objective: To assess the incidence and predictors of mortality among Traumatic brain injury patients admitted to comprehensive specialized hospitals in the Amhara region. 2022 Method: An institution-based retrospective follow-up study was conducted among 544 traumatic brain injury patients admitted from January 1, 2021, to December 31, 2021. A simple random sampling method was used. Data were extracted using a pre-tested and structured data abstraction sheet. Data were entered, coded, and cleaned into EPi-info version 7.2.0.1 software and exported to STATA version 14.1 for analysis. Results were explored using descriptive statistics and Kaplan–Meier failure curve together with the log-rank test was fitted to explore the survival difference among groups. The Weibull regression model was fitted to determine the association between mortality and covariates. Variables with a P-value < 0.05 were declared statistically significant. Results: The overall incidence of mortality among traumatic brain injury patients was 1.23 per 100 person-day observation [95% (CI: 1.0, 1.5)] with a median survival time of 106 days. Age [AHR:1.08; (95% CI;1.06,1.1)], severe TBI [AHR:10;(95% CI;3.55,28.2)], moderate TBI [AHR: 9.2;(95% CI 2.97,29)],hypotension (AHR: 6.9 [95% CI; 2.8-17.1]), coagulopathy [AHR:2.55, (95%CI:1.27, 5.1)], hyperthermia [AHR: 2.79; (95% CI; 1.4-5.5)] and hyperglycemia [AHR: 2.28; (95% CI; 1.13-4.6)] were positively associated with mortality, while undergoing neurosurgery was negatively associated with mortality [AHR: 0.47; (95%CI; 0.27-0 .82)]. Conclusion: The overall incidence of mortality was found to be high.Age, lower admission GCS hypotension at admission, coagulopathy, presence of associated aspiration pneumonia, undergoing a neurosurgical procedure, episode of hyperthermia, and hyperglycemia during hospitalization were the independent predictors of mortality. Therefore, intervention to reduce mortality should focus on the prevention of primary injury and secondary brain injury. Keywords: Traumatic Brain Injury, incidence, mortality, Ethiopia