Name: JESSICA VAZ GONCALVES
Publication date: 06/10/2023
Examining board:
Name |
Role |
|---|---|
| FERNANDO ZANELA DA SILVA AREAS | Advisor |
Summary: Severe Traumatic Brain Injury (TBI) is a significant global public health issue,
considered the leading cause of mortality and disability in young adults. Some clinical,
neurosurgical, and sociodemographic factors have already been described as
predictors of higher risks of in-hospital mortality and lower levels of functional recovery
after the traumatic event. Identifying these predictive factors is crucial for guiding
treatment and prognosis strategies, as well as shaping public health policies for this
population. The aim of this study was to identify predictors of mortality and functional
recovery from hospital admission up to 12 months after severe TBI. This was a
prospective observational cohort study conducted at a trauma referral hospital in the
state of Espírito Santo, Brazil. All individuals diagnosed with severe TBI over the age
of 18 admitted within a one-year period were included. The analyzed outcomes were
in-hospital mortality and functional recovery assessed using the Extended Glasgow
Outcome Scale (GOSE) at the time of hospital discharge, 3, 6, and 12 months after
TBI. After applying the inclusion criteria, 383 patients were included, of which 211
(55%) died, and 172 (45%) survived hospitalization. Among these, 145 completed the
one-year follow-up. The mean age was 49 years, 80% were male, and falls (46.5%)
were the main cause of injury. In the final binomial logistic regression model, age over
65 years, days on mechanical ventilation, and low educational level were strong
predictors of unfavorable functional recovery over the 12 months following the trauma.
Pupillary changes, such as anisocoria and mydriasis, high respiratory rate, decreased
body temperature, ISS scores >25, and the performance of decompressive
craniectomy were associated with a higher risk of in-hospital mortality. This study was
the first to investigate predictors of mortality and functional recovery one year after
severe Traumatic Brain Injury in the Brazilian population. The higher mortality rate in
TBI patients compared to both high-income countries (HICs) and low- and middle-
income countries (LMICs) underscores the importance of considering regional
disparities when developing and implementing TBI management strategies worldwide.
