Time-related outcome in patients with traumatic brain injury admitted to neurosurgical care in a tertiary centre

Time-related outcome in patients with traumatic brain injury admitted to neurosurgical care in a tertiary centre: David O Udoh, Oduwa O Aghahowa, Emmanuel C Obeta



Archives of International Surgery 2018 8(3):95-100



Background: The decreased mortality and improved outcomes associated with constantly metamorphosing trauma systems is particularly relevant in traumatic brain injuries (TBI) in which the duration from injury to neurosurgical intervention is an important determinant of outcome. With defective organization of trauma systems comes reduced access to quick and effective neurosurgical care which impact inexorably on outcomes. Using a time honoured scale, we took a critical look at TBI outcomes on the background of time of arrival to specialist neurosurgical care. We sought the association of various demographic factors with outcomes of traumatic brain injury in patients who arrived at our neurosurgical facility at various time intervals following injury.

Patients and Method: A retrospective study of 385 of 483 patients with TBI admitted to neurosurgical care from 2009 to 2011 at our teaching hospital. Data was obtained from a computerized log of all TBI patients, case files and intensive care unit records, and analyzed using STATA software version 12.

Results: Seventy percent (70%) of the patients arrived within 24 hours, especially between 12 to 24 hours i.e. 27.01%. However, only 5.71%, comprising those with mean age 22.59(±12.31) years arrived within the first hour Young patients arrived significantly earlier to specialized care than those ≥40 years. Regardless of injury duration, most patients had severe TBI (p value 0.012). Most, 77.69%, outcomes were favourable (Glasgow outcome scores, GOS, 4 and 5); 16.54% died (GOS 1). The middle strata of GOS 2 and 3 were almost absent. Injury duration did not influence duration of intensive care or overall hospital stay. Mortality was highest after 24hours.

Conclusion: There is a dearth, in this region, of any auditing of the relationship between time of arrival of patients with TBI to specialized care, recovery characteristics (post-neurosurgical care) and eventual outcome using the Glasgow outcome scale.