Mild TBI Mortality Reaches 13.6% at 12 Months

TOPLINEAmong patients with mild traumatic brain injury (mTBI), 12-month cumulative mortality reached 13.6%, with patients presenting Glasgow Coma Scale (GCS) scores of 13 or 14 experiencing mortality rates exceeding 20% — more than double the rate observed in those with GCS scores of 15, a prospective study in Pakistan showed.METHODOLOGYThis prospective cohort study used data from a multicenter trauma registry at two tertiary care centers in Karachi, Pakistan, from 2021 to 2024.A total of 602 adults (55.8% aged 18-39 years; 83.4% men) admitted with mTBI (GCS scores of 13-15) were included and followed up at 1, 3, 6, and 12 months.Most patients experienced mTBI from road traffic collisions (71.1%) or falls (21.6%).The primary outcome was inpatient and postdischarge mortality (12-month cumulative and follow-up). Secondary outcomes included quality of life (QoL) assessed using revised-trauma QoL and disability assessed using functional independence measure.The analysis was adjusted for age group, sex, mechanism of injury, injury severity score category, comorbidities, GCS score, and surgical intervention.TAKEAWAYInpatient, cumulative 1-month, and 12-month mortality rates were 4.6%, 8.9%, and 13.6%, respectively, with patients with GCS scores 13 (20.2%) and 14 (20.1%) experiencing higher mortality rates at 12 months compared with those with GCS score 15 (8.3%). GCS scores 13 (adjusted hazard ratio [aHR], 1.96; 95% CI, 1.06-3.64) and 14 (aHR, 2.28; 95% CI, 1.23-4.22) were associated with significantly higher mortality compared with a GCS score 15.Patients aged 60 years or older had higher mortality in adjusted analysis (aHR, 2.98; 95% CI, 1.44-6.13) compared with those aged 18 to 39 years.Surgical interventions were performed in 29.2% of cases, mostly craniotomies (43.3%), burr holes (16.3%), and craniectomies (15.6%). Surgery was associated with lower odds of mortality (aHR, 0.49; 95% CI, 0.26-0.94).Of 345 patients followed up at 12 months, 78% achieved complete independence. At 12 months, 92.2%, 17.1%, and 72.2% of patients reported no disability in functional engagement, physical well-being, and emotional well-being, respectively. Patients with GCS scores 13 (odds ratio [OR], 2.11; 95% CI, 1.19-3.72) and 14 (OR, 1.84; 95% CI, 1.07-3.16) had higher odds of worse emotional well-being than those with a GCS score 15.IN PRACTICE"Our findings underscore the need for structured post-discharge follow-up for high-risk patients. Given the observed mortality and impaired QoL, these results also suggest that current mTBI classifications inadequately capture injury severity in LMIC [low- and middle-income country] settings, warranting reconsideration of mTBI definitions in these contexts," the investigators wrote.SOURCEThe study was led by Kantesh Kumar, MBBS, Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan. It was published online on August 13 in JAMA Network Open.LIMITATIONSThe findings were not generalizable to rural hospitals with greater resource constraints. The study captured only admitted patients, excluding those managed and discharged directly from the emergency department, representing a more severely affected, hospitalized subgroup. Inclusion of patients with complicated mTBI may have overestimated mortality. Additionally, the surgery-mortality association may have been influenced by a potential selection bias.DISCLOSURESThe study was funded by the Fogarty International Centre of the National Institutes of Health. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.