Determinants of hospital mortality among patients presenting with Traumatic Brain Injury at the University Teaching Hospital, Lusaka, Zambia

Background: Traumatic brain injury (TBI) is a major cause of mortality and long-term disability and economic loss to society. Studies on TBI are scarce and mostly originate from high-income countries. Low- and middle-income countries (LMICs) experience the majority TBIs, yet few studies have examined the patterns of TBIs and the factors associated with mortality. In Zambia, the burden of TBIs is high while the mortality trends remain poorly documented. This study aimed to assess the determinants of in hospital mortality among patients presenting with TBIs at the University Teaching Hospital Lusaka, Zambia. Methodology: This was a study conducted among TBI patients at the University Teaching Hospital (UTH) from September 1st to December 31st, 2023. All TBI patients, regardless of severity, were included. Data analysis was performed using Stata Version 16. Descriptive statistics were used to present the data. The Chi-square test was used to analyze associations between categorical variables. Binary logistic regression was used to calculate the odds of mortality for each predictor variable. A p-value < 0.05 was considered statistically significant in all cases. Results: The study included 143 cases of TBI, with 13 resulting in death, a mortality rate of 10%. The average age of deceased patients was 39 years (SD 19), while that of the discharged patients was 32 years (SD 14). A low Glasgow Coma Scale (GCS) score at presentation was associated with mortality. Each unit increase in GCS score was associated with 0.761 lower odds of mortality (95% CI: 0.578, 1.00, p=0.05). Patients who died had a median GCS score of 7/15, while discharged patients had a median GCS score of 14/15. Patients with subarachnoid hemorrhage accounted for the highest proportion of deaths, and this finding was statistically significant (p=0.008). Patients with a history of seizures after injury were 9.324 times more likely to die (95% CI: 1.12, 7.95, p=0.039). Mechanical ventilation was associated with 20.63 higher odds of mortality (95% CI: 1.93, 220, p=0.012). Conclusion: TBI is a significant public health issue in Zambia, particularly among young males, primarily caused by road traffic accidents and assaults. Many patients arrive late and without medical care at the site of their injury, and those with severe TBI requiring mechanical ventilation and post-traumatic seizures have a higher mortality risk. To address TBI, improvements in road safety measures, emergency ambulance services, and trauma care systems are recommended.