Predicting mortality from head injury: experience of Sancti Spíritus province, Cuba

Abstract

INTRODUCTION: Better prognostic classification of patients who are severely injured or in critical condition has been associated with reduced case fatality from traumatic brain injury. OBJECTIVE: Determine the value of admission results (clinical, laboratory and imaging) and severity scales, for predicting mortality in traumatic brain injury patients. METHODS: A cross-sectional study of traumatic brain injury patients was conducted at the Sancti Spíritus Provincial General Teaching Hospital in 2009 and 2010; the study population included all 16 traumatic brain injury patients who died during the period, plus 31 who survived to discharge. The following independent variables were used: Glasgow Coma Scale, Glasgow Coma Scale motor score, pupil reaction to light, blood glucose, respiratory distress, systolic blood pressure, hemoglobin, and lesions detectable on cranial computed tomography. Associations between independent and dependent variables (death or survival to discharge) were analyzed using the chi-square test and, for cells with expected values of <5, the Fisher exact test. Odds ratios and 95% confidence intervals were calculated. RESULTS: Of 47 patients, 20 (42.6%) were aged >60 years and 32 (68.1%) were male. Parameters associated with higher mortality identified were: Glasgow Coma Scale score <8 (OR 47.25, 95% CI 6.26-483.3, p <0.001) and Glasgow Coma Scale motor score <3 (OR 28.00, 95% CI 4.20-220.2, p <0.001); absence of pupil reaction (OR = 8.40, 95% CI 1.20-73.35, p <0.001), respiratory distress (OR = 47.25, 95% CI 1.85-85.92, p <0.0014), blood glucose >8.8 mmol/L (OR = 7.26, CI 1.28-46.18, p <0.001), subdural hematoma (OR 20.25, 95% CI 3.55-136.65, p <0.001) and multiple injuries detected by cranial computed tomography (OR = 29.25, 95% CI 4.64-228.43, p <0.001). CONCLUSIONS: The study confirmed value in Sancti Spíritus Province of the following for predicting mortality in head injury patients: Glasgow Coma Scale score <8, Glasgow Coma Scale motor score <3, blood glucose >8.8 mmol/L, absence of pupil reaction to light, respiratory distress, and presence of multiple injuries detected in cranial computed tomography. No prognostic value was demonstrated for low hemoglobin values or abnormal blood pressure.