The Use of Corticosteroid Randomisation after Significant Head Injury (CRASH) Prognostic Model as Mortality Predictor of Traumatic Brain Injury Patients Underwent Surgery in Low-Middle Income Countries

Abstract

Background. Traumatic brain injury (TBI) is a disruption to normal brain functions caused by traumas such as collisions, blows, or penetrating injuries. There are factors affecting patient outcomes that also have a predictive value. Limited data from low-middle income countries showed a high number of poor outcomes in TBI patients. The corticosteroid randomisation after significant head injury (CRASH) prognostic model is a predictive model that uses such factors and is often used in developed countries. The model has an excellent discriminative ability. However, there is still a lack of studies on its use in surgical patients in low-middle income countries. This study aimed to evaluate the CRASH model’s validity to predict 14-day mortality of TBI patients who underwent surgery in low-middle income countries. Methods. This retrospective analytical observational study employed total sampling including all TBI patients who underwent surgery with general anesthesia from January to December 2022. Statistical analysis was performed by applying Mann–Whitney and Fisher exact tests, while the model’s discriminative ability was determined through the area under the curve (AUC) calculations. Results. 112 TBI patients were admitted during the study period, and 74 patients were included. Independent statistical analysis showed that 14-day mortality risk, age, Glasgow Coma Scale score, TBI severity, pupillary response, and major extracranial trauma had a significant individual correlation with patients’ actual mortality outcome (p<0.05). The AUC analysis revealed an excellent mortality prediction (AUC 0.838; CI 95%). Conclusion. The CRASH prognostic model performs well in predicting the 14-day mortality of TBI patients who underwent surgery in low-middle income countries.