Title : Functional outcomes of traumatic brain injury in India: a multi-centric cohort study (2021-2024)
Abstract:
Traumatic Brain Injury (TBI) is a public health concern worldwide including India and other developing nations causing the leading cause of death and disability. This is the first study from Indian subcontinent to prospectively assess outcomes in severe/moderate TBI patients across multiple tertiary care centers.
Objective: To prospectively assess the functional outcome over time in severe/moderate TBI patients at discharge, 3, 6, and 12 months.
Design: This cohort study is a part of the already ongoing TBI-ML (Traumatic Brain Injury-Machine Learning) study.
Setting: The study collected outcome data prospectively from June 2022 to June 2024 from three tertiary care centers located in different parts of India.
Participants: The participants included all patients who entered the hospital's emergency department (ED) within 72 hours of injury with Glasgow Coma Scale (GCS) scores 3-12 and were subsequently admitted to ICU.
Exposure Severe/Moderate TBI. Main Outcomes: The Glasgow Outcome Scale (GOS) assessed the functional status of patients with severe/moderate TBI at discharge, 3 months, 6 months, and 12 months. The GOS score was dichotomized to determine favorable and unfavorable outcomes.
Results: The study included 1,276 patients with severe TBI and 833 patients with moderate TBI. The median age for severe TBI was 33 years (IQR: 22-49), with 82% male, while for mild TBI, it was 35 years (IQR: 22-53), with 25% male. At AIIMS, Delhi, the incidence of favorable outcomes at six months was observed at 30% for severe cases and 34% for moderate cases. MMC, Chennai reported the highest incidence of favorable outcomes at discharge: 25% for severe cases and 78% for moderate cases. In AIIMS, Patna, most recoveries occurred within three months, with incidences of 29% for severe cases and 67% for moderate cases. Mixed effects logistic regression indicated that the odds of achieving a favorable functional outcome were highest at six months post- injury (OR: 3.68; 95% CI: [2.91,4.67]).
Conclusion and Relevance: The likelihood of achieving a favorable outcome increases over time, peaking at six months post-injury. The incidence of favorable outcomes varied across centers, with MMC, Chennai reporting higher rates at discharge, AIIMS, Patna had significant recovery within three months, and AIIMS, Delhi by the time of six months.
