Predictors of In-Hospital Mortality and Years of Life Lost in Patients with Severe Traumatic Brain Injury: A Retrospective Study in the Metropolitan Region of Vitória, Brazil

Abstract

Abstract Traumatic Brain Injury (TBI) poses a notable incidence in both developed countries and emerging economies worldwide. Each year, approximately 70 million people are affected by TBI, and around 11% of these events are classified as severe. Data from the Global Burden of Disease (GBD) in 2019 revealed that Brazil accounts for 1.1% of all moderate/severe TBI incidents worldwide. Within this context, falls stand out as the primary cause, representing 67% of cases. Analyzing the statistics at the state level, it is observed that Espírito Santo is responsible for 14% of all TBI incidents in Brazil, with falls also being the main cause, at a percentile of 67%. The discovery of predictors of TBI mortality is crucial to support intervention and prognosis strategies, potentially guiding public health policies. Due to the scarcity of studies in this area, our objective was to identify predictors of mortality in severe TBI and analyze the burden of TBI in the metropolitan region of Vitória, Espírito Santo. We conducted a retrospective observational cohort study at a trauma reference hospital in the state, including all individuals diagnosed with severe TBI from 2019 to 2022. The dependent variable analyzed was the outcome of hospital mortality. After applying the inclusion criteria, 863 individuals were included in the study, of which 450 (52.14%) had a fatal outcome, and 413 (47.86%) survived. The mean age was 48.67 years, with 82.5% being male. Falls (55.56%) were the leading cause of death in the population. The final binomial logistic regression model indicated that age up to 59 years, time up to 10 days in orotracheal intubation (OTI), and the type of trauma from falls were variables with notable predictive power for severe TBI-related mortality in the population. The calculation of Years of Life Lost (YLLs) revealed that TBI had an accumulated impact of 10,870.23 years of life lost prematurely in the study population. This is the first retrospective study to analyze predictive variables and the burden of TBI in the Greater Vitória region. However, it is important to note that unanalyzed factors may influence outcomes, such as the sample restriction to patients from a single reference hospital in the region, potentially limiting the understanding of variations in epidemiological profiles and adjacent health services.