Characteristics and Outcome of Patients with Traumatic Brain Injury in the Intensive Care Unit of a Public Sector Hospital in Karachi, Pakistan

Abstract

Objective: To determine the characteristics, management and outcome of patients with traumatic brain injury (TBI) and associated risk factors. Methods: This cross-sectional study was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma from January 2018 to April 2019. TBI patients ≥16 years of age that were admitted to the intensive care unit (ICU) or high dependency unit (HDU) and managed conservatively or surgically, were included. Central nervous system (CNS) infection, mortality and associated risk factors were noted. Results: The mean age was 30.9 ± 13.6 years with 116 (91.3%) males. CNS infection developed in 72 (56.7%) patients. Of 72, 29 (40%) had positive CSF culture and in 28 (38.8 %) multidrug resistant Acinetobacterspp. susceptibile to only colistin was reported. Antimicrobial therapy with intravenous colistin with meropenem was used in 63 (87.5%) patients. A significant association of CNS infection was found with age (p-value 0.047), cerebrospinal fluid (CSF) leak at presentation (p-value 0.045), type of surgery (p-value 0.001), and duration of ER stay (p-value 0.047). Mortality occurred in 83 (65.4%) patients. A significant association of mortality was found with low Glasgow coma score (GCS) at presentation (p-value 0.031), CSF leak at presentation (p-value <0.001), intraventricular hemorrhage, TBI type (p-value <0.001), polytrauma (p-value 0.003), CNS infection (p-value <0.001), and duration of emergency room stay (p-value 0.009). Conclusion High mortality was observed in patients with traumatic brain injury. Intracranial infection is strongly correlated with mortality underscoring the need for strict infection control and prevention measures.

Keywords

• Traumatic Brain Injury
• Central Nervous System Infection
• Intensive Care Units
• Neurosurgical Procedures