Traumatic brain injury in the Brazilian Amazon: A neglected disease

Background: Traumatic brain injuries (TBIs) are associated with a high mortality rate, especially in areas with poor availability of resources as seen in Low and Middle-income countries (LMICs). There are limited data on remote regions like the Brazilian Amazon. We aimed to identify the epidemiology profile and the predictive factors for lethality within 14 days of TBI. Methods: We conducted a prospective observational clinical study that consecutively enrolled TBI patients. We collected clinical, laboratory, and tomographic parameters to analyze the association with mortality rates. The primary outcome was death within 14 days of admission. A multivariate analysis was performed to identify the predictive mortality factors. Results: 469 patients were included. The majority were male (88.22 %) with mean age of 37.6 ± 15.5. 59.3 % presented with severe or moderate TBI. The main trauma mechanism was road traffic accident (57.1 %) followed by assault (18.6 %) and fall from height (15.6 %). 14-day mortality was 27.4 % (n = 128) and, 81.3 % (n = 104) died within 24 h after trauma. In patients with severe TBI, the case fatality rate was 70.2 %, whereas in moderate and mild, was 17.5 and 2.1 %, respectively. The main predictors for mortality were the Glasgow Coma Scale (GCS), pupil reactivity, hypoxia and hypotension. A prognostic model with only these four variables determined an AUC of 0.92. Conclusion: The 14-day mortality of patients suffering from severe and moderate TBI in the Amazon is extremely high. In this cohort, we identified that the prognostic factors in TBI were GCS, pupillary reactivity, hypoxia and hypotension with a model reaching high accuracy.