Factors associated with mortality of patients admitted with traumatic brain injury at the main intensive care unit, university teaching hospitals, Lusaka – Zambia.

Abstract

BACKGROUND Traumatic brain injury (TBI) is a common pathology in the main intensive care unit (MICU) at University Teaching Hospitals (UTH), with patients being admitted for airway protection, stabilisation, and close monitoring of vitals, thus helping prevent secondary brain injury. Mortality of these patients was previously found to be high at 66%, however, it is not known whether physiological factors on admission of these patients to MICU are associated mortality. It is important to study these factors to develop proper admission criteria for these patients being admitted to MICU. This study aimed to evaluate the current mortality rate of patients admitted with TBI in MICU at UTH and to explore neuro physiological factors associated with their mortality. METHODS This was a cross-sectional study done in MICU at UTH in Lusaka, Zambia. 78 participants were enrolled, but one was excluded after transfer to another facility. Upon admission to MICU, the following data was collected: age, gender, mechanism of injury, admission vital signs (mean arterial pressure, body temperature, random blood sugar), admission Glasgow Coma Scale, presence, or absence of convulsions and anisocoria, and the time interval between injury and arrival at UTH. Participants were followed up till either discharge from MICU or death. Statistical analysis was done using Stata. RESULTS The mean age of the participants was 30.9, majority of the participants being male (84%). Out of the 77 participants in the analysis, 25 (32%) were discharged from MICU and 52 (68%) died. There was no significant difference in the mean MAP, mean body temperature or mean random blood sugar on admission to MICU between the group discharged from MICU and the group which died. An admission GCS of between 3 and 8 was significantly associated with higher mortality (p<0.001), as well as presence of convulsions during admission (p=0.028). Only 2% of the participants reached UTH within an hour of injury, and a delay of more than 12 hours between injury and arrival at UTH was significantly associated with higher mortality. CONCLUSIONS The current mortality rate of patients admitted with TBI in the MICU at UTH remains high and there is need for improvement in timely admission and management of these patients in MICU. Majority of the patients delayed reaching reasonable care at UTH and this significantly impacted mortality. Increased severity of TBI and presence of convulsions were also associated with higher mortality.