Evaluation of Admission Brain Computed Tomography Findings to Predict the Long-term Outcomes of Patients with Traumatic Brain Injury

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Abstract Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes. Materials and Methods Patients admitted to a tertiary emergency hospital between March 2017 and April 2018 who had suffered a TBI and had undergone a brain CT scan within 12 hours of the trauma were prospectively evaluated. All of the patients who were hospitalized for at least 24 hours were contacted by phone after 12 months to evaluate their neurological condition. Results We achieved a 12-month follow-up with 180 patients, most of them male (93.33%). The brain changes identified by CT, such as brain contusion (BC; p = 0.545), epidural hemorrhage (EDH; p = 0.968) and skull base fracture (SBF; p = 0.112) were not associated with worse neurological outcomes; however, subdural hemorrhage (SDH; p = 0.041), subarachnoid hemorrhage (SAH; p ≤ 0.001), brain swelling (BS; p ≤0.001), effacement of cortical sulci (ECS; p = 0.006), effacement of basal cisterns (EBC; p ≤0.001), depressed skull fracture (DSF; p = 0.017), and a brain midline shift > 5 mm (p = 0.028) were associated with worse outcomes. Conclusion Findings such as SAH, BS and DSF were independent predictors of worse neurological outcomes. The rate of 70% of patients lost to follow-up shows the difficulties of conducting long-term research in LMICs.

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