Prognostic factors in moderate and severe traumatic brain injury: A multivariate statistical analysis

Abstract

Background: Moderate-to-severe traumatic brain injury (TBI) is a major public health burden in middle-income countries, yet local prognostic data are scarce. This study aims to define the epidemiological profile, management, and predictors of outcomes in TBI patients surviving the initial phase in a Moroccan university hospital. Methods: A retrospective observational study was conducted on 133 consecutive patients admitted for moderate-to-severe TBI at the Hassan II University Hospital in Fes between 2022 and 2023. Demographic, clinical, radiological, and therapeutic data were collected. Multivariate logistic regression was used to identify independent predictors of an unfavorable outcome (defined as death or major disability, with a Glasgow Outcome Scale score of 1-3) at 28 days. Results: The cohort was predominantly composed of young men (78.2%), with a median age of 28 years. Road traffic accidents were the leading cause of injury (47.4%). The overall mortality rate at 28 days was 13.5%. Five independent predictors of an unfavorable outcome were identified: age over 65 years (odds ratio [OR] = 4.2), an initial Glasgow Coma Scale (GCS) score ≤8 (OR = 3.8), the presence of bilateral brain lesions (OR = 2.9), persistent arterial hypotension (OR = 2.4), and a time-to-management exceeding 4 h (OR = 1.9). The predictive model demonstrated excellent discrimination (area under the curve = 0.91). Conclusion: In our setting, moderate-to-severe TBI primarily affects a young population, mainly as a result of road accidents. Age, initial GCS score, the extent of lesions, hemodynamic instability, and treatment delays are major determinants of prognosis. These findings highlight the critical importance of early diagnosis and rapid intervention to improve patient outcomes.