Predictive Factors for Fatality After Traumatic Brain Injury Among Road Traffic Crash Victims in Addis Ababa City, Ethiopia

Mengistu, Zuriyash; Ali, Ahmed; Abegaz, Teferi · 2021 · Crossref

DOI: 10.21203/rs.3.rs-956900/v1

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Summary

This prospective cohort study investigates the predictive factors for short-term mortality among victims of road traffic crashes who suffer severe traumatic brain injury (TBI) in Addis Ababa, Ethiopia. Motivated by the high burden of TBI-related mortality and disability in low- and middle-income countries, and the limited local data on early mortality predictors, the research aims to identify clinical and demographic risk factors associated with death within 30 days of injury. The study was conducted between February 2018 and November 2019 across three tertiary hospitals in Addis Ababa: Tikur Anbessa Specialized Hospital, AaBET Hospital, and Minilic II Hospital. The researchers enrolled 242 patients aged 18 or older who were diagnosed with severe TBI based on Computed Tomography findings and an Abbreviated Injury Score of 4 or higher. Data were collected within 24 hours of admission, capturing socio-demographic characteristics and clinical variables such as Glasgow Coma Scale (GCS) scores, body temperature, systolic blood pressure, and oxygen saturation. Patients were followed for up to 30 days or until death. Statistical analysis employed Survival Analysis techniques, including Kaplan-Meier estimates, Log-rank tests, and multivariable Cox proportional hazards regression to determine hazard ratios for mortality. The overall mortality rate was 30.2%, with 73 deaths observed among the 242 participants. The cohort was predominantly male (81%) with a median age of 29 years. Multivariable analysis identified several significant predictors of increased mortality hazard. Patients with subnormal body temperature (hypothermia) had a 1.64 times higher hazard of death compared to those with normal temperature. A GCS score below six was associated with a 5.61 times higher hazard of death compared to scores between six and eight. Additionally, patients presenting with TBI plus other traumatic injuries had a 1.89 times higher hazard of death than those with isolated TBI. While hypotension and hypoxia showed strong associations in bivariate analysis, they did not remain statistically significant in the final multivariable model. The study confirmed that the proportional hazards assumption was met for the model. The findings highlight a high early mortality rate for severe TBI in this setting, driven significantly by low GCS scores, hypothermia, and concurrent injuries. The authors conclude that these results underscore the urgent need for improved pre-hospital care programs, particularly advanced neurosurgical interventions and immediate management of physiological insults like hypoxia and hypotension. Such measures are critical to preventing secondary brain injury and reducing mortality among road traffic crash victims in Ethiopia.

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• fatality injury trends