Moderate and Severe Traumatic Brain Injury Outcomes-A 20 Year (2002-2021) Analysis

Although recognised as a leading cause of death and disability, it is unclear whether current treatment strategies have improved outcomes from blunt moderate to severe traumatic brain injuries (msTBI) due to a lack of available epidemiological data. This study sought to determine if in-hospital mortality and early functional outcomes of msTBI patients have changed over 20 years. Early functional outcomes were determined through the surrogate measure of the proportion of patients discharged directly to home.

A longitudinal cohort study using The Alfred Health Trauma Registry data. Subjects were aged 16-70 years with blunt msTBI (Head Abbreviated Injury Scale 3-5) admitted to The Alfred Trauma Service between 1 January 2002 and 31 December 2021.

A total of 8222 patients presented with msTBI over the period, with 692 deaths (8.5%). Unadjusted in-hospital mortality decreased from 12.1% in 2002 to 4.0% in 2021 (OR 0.96, 95% CI 0.95-0.97, p < 0.001). Sensitivity analysis demonstrated a statistically significant reduction in the odds of death even after adjusting for injury severity (OR 0.96, 95% CI 0.93-0.99, p < 0.0001). The proportion of patients discharged to home increased from 30.6% to 60.8% over the period (OR 1.05, 95% CI 1.04-1.06, p < 0.001).

There was a reduction in in-hospital mortality and an increase in the proportion discharged home for adults hospitalised with msTBI at The Alfred Hospital over the last two decades. These results foster optimism for the care of neurotrauma patients, but further research is required to identify the modifiable factors associated with these improved outcomes.