The "Talk and Die" phenomenon in traumatic brain injury: A meta-analysis

Risk factors for "Talk and Die" phenomenon following Traumatic Brain Injury (TBI) are poorly identified in literature, and studies attempting to identify those factors yielded conflicting results.

To provide level 1 evidence on the significance of potential risk factors predictive of "Talk and Die" phenomenon following TBI.

A systematic review and meta-analysis were performed. A fixed effect model for age, admission Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS), and Injury Severity Score (ISS) parameters were performed.

Of 35,582 patients analyzed, 2397 patients experienced the "Talk and Die" phenomenon. Absence of intracranial hematoma (OR=0.137, CI: 0.276-0.991, =0.047), Older age (Hedge's g=0.153, CI: 0.104-0.202, p < 0.001), lower GCS score (Hedge's g=-0.111, CI: 0.062-0.160, p < 0.001), lucid interval duration of ≥ 24 h (OR=4.176, CI: 2.806-6.215, p = 0.000), higher AIS scores (Hedge's g was 0.138, CI: 0.089-0.188, p < 0.001), and lower ISS scores (Hedge's g=0.137, CI: 0.088-0.186, p < 0.001) were identified as risk factors for mortality.

Considering our results and others, we conclude that absence or presence of intracranial hematomas, older age, lower GCS, lucid interval ≥ 24 h, High AIS, and low or high ISS predispose to a "Talk and Die" phenomenon following a Traumatic Brain Injury.