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Clinical characteristics and prognosis of traumatic head injury following road traffic accidents admitted in ICU “analysis of 694 cases”

  • Hedi Chelly
  • Mabrouk BahloulEmail author
  • Rania Ammar
  • Ahmed Dhouib
  • Khaireddine Ben Mahfoudh
  • Mohamed Zaher Boudawara
  • Olfa Chakroun
  • Imen Chabchoub
  • Anis Chaari
  • Mounir Bouaziz
Original Article

Abstract

Background

The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis.

Methods

A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay.

Results

There were 592 males (85.3%), and 102 female patients. The mean age was at 31.8 ± 17.8 years (range 1–91). The mechanism of the accident was detailed in 666 patients (96%). The majority of the victims were motorcycle riders and/or passengers (40.5%), followed by pedestrians (29.1%). Extra-cranial pathology was present in 452 patients (65%). A total of 677 patients (97.6%) required intubation, mechanical ventilation, and sedation. Mean ICU stay was 16 ± 17.4 days. A total of 187 patients (26.9%) died during their hospital stay. The GOS performed within a mean delay of 6 months after hospital discharge was as follows: 198 deaths (28.5%), 13 vegetative state (1.9%), and 349 (50.3%) good recovery and/or moderate disability. A multivariate analysis showed that the factors which correlated with a poor prognosis (mortality and severe disability) were: age > 38 years, Glasgow coma scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic).

Conclusion

In Tunisia, traumatic brain injury due to RTAs is a frequent cause of ICU admission, especially among young adults, and is associated with high mortality and morbidity rates. The majority of the victims were motorcycle riders and/or passengers and pedestrians. The factors associated with a poor outcome were: age > 38 years, Glasgow Coma Scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). As a consequence, prevention is highly warranted.

Keywords

Trauma Head injury Road traffic accident Intensive care unit Multivariate analysis Prognosis 

Abbreviations

TBI

Traumatic brain injury

ICU

Intensive Care Unit

RTAs

Road traffic accidents

CT

Computed cerebral tomography

GCS

Glasgow coma scale score

SAPSII

Simplified acute physiology score

PRISM

Pediatric risk of mortality

PTS

Pediatric trauma score (PTS)

DAI

Diffuse axonal injury

ICP

Intracranial pressure

SSIs

Secondary systemic insults

GOS

Glasgow outcome scale

SDH

Subdural hematoma

Notes

Acknowledgements

All authors thank Professor Chokri Khalaf for his help in the redaction of this manuscript.

Author contributions

All authors contributed to study conception and design, data analysis, and drafting the manuscript. HC and MB contributed to data analysis and statistical analysis. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Availability of data and materials

The data sets were analyzed during the current study available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The study was approved by an Internal Review Board.

Funding

This study received no funding.

Consent for publication

Not applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Hedi Chelly
    • 1
  • Mabrouk Bahloul
    • 1
    Email author
  • Rania Ammar
    • 1
  • Ahmed Dhouib
    • 1
  • Khaireddine Ben Mahfoudh
    • 2
  • Mohamed Zaher Boudawara
    • 3
  • Olfa Chakroun
    • 4
  • Imen Chabchoub
    • 5
  • Anis Chaari
    • 1
  • Mounir Bouaziz
    • 1
  1. 1.Department of Intensive CareHabib Bourguiba University HospitalSfaxTunisia
  2. 2.Department of RadiologyHabib Bourguiba University HospitalSfaxTunisia
  3. 3.Department of NeurosurgeryHabib Bourguiba University HospitalSfaxTunisia
  4. 4.Departement of Emergency MedicineHabib Bourguiba University HospitalSfaxTunisia
  5. 5.Department of PediatricsHedi Chaker University HospitalSfaxTunisia

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