Predictors of 30-day mortality among patients with head trauma: a prospective cohort study

Abstract

Background
Worldwide, head injuries are a leading cause of morbidity and death.


Purpose
This study sought to determine how well the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Acute Physiology and Chronic Health Evaluation II (APACHE II), and other factors like age, sex, lab results, and complications could predict the death of patients with traumatic brain injury (TBI) in the intensive care unit (ICU).


Methods
This prospective cohort research included 140 patients, both male and female, aged > 16, with acute TBI who arrived at the emergency room within 24 h of the event and had a GCS of less than 15, and were included in this prospective cohort research. The patients were split into two groups: 34 patients who were not survivors and 106 patients who were survivors.


Results

Univariate regression showed GCS, RTS, APACHE II, age, urea, sodium (Na), random blood sugar (RBS), international normalized ratio (INR), creatine kinase (CK), and myoglobin and pneumonia as significant 30-day mortality predictors in ICU TBI patients (
P
 < 0.05), while septic shock and Acute Respiratory Distress Syndrome (ARDS) were not. GCS ≤ 9, RTS ≤ 10, and APACHE II > 13 predicted mortality with good sensitivity and specificity. Survivors had higher GCS/RTS and lower APACHE II scores and needed mechanical ventilation (
P
 < 0.001).



Conclusions
APACHE II, GCS, and RTS predicted 30-day mortality in ICU TBI patients. Mortality correlated with older age, comorbidities, mechanical ventilation, complications (pneumonia, ARDS, septic shock), and elevated urea, Na, RBS, INR, CK, and myoglobin.