Management of Severe Head Injuries in the Intensive Care Unit at Dalal Jamm National Hospital

Objective: To evaluate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary aspects of severe traumatic brain injuries (TBI) admitted to the intensive care unit at Dalal Jamm National Hospital. Methodology: This is a retrospective, descriptive, and analytical study conducted over a period of 30 months (January 2022–June 2024) on patients with severe TBI, Glasgow ≤ 8, admitted to the intensive care unit at Dalal Jamm Hospital. Results: The incidence of severe TBI was 5.1% with a mean age of 21.98 years (range 18 months to 67 years). Males predominated with a sex ratio of 5. The 15-30 age group was the most affected. Road traffic accidents were the most common cause (63% of cases), followed by falls due to work-related or recreational accidents (26%). Medical transport was used for 17% of patients. The average time to admission to intensive care was 2.39 hours. A Glasgow Coma Scale score between 3 and 4 was noted in 10% of patients, 30% had a score between 5 and 6, and 60% between 7 and 8. Brain CT scans were performed in 90% of cases. Severe TBI was part of multiple trauma in 60% of cases. Edematous-hemorrhagic contusion was the most frequently found lesion (33%). The secondary systemic cerebral injuries (SSCI) noted were arterial hypotension (46.67%), acute anemia (40%), and arterial hypertension (23.33%). All patients were intubated, ventilated, and sedated. Surgical indications were established in 36.6% of patients, and surgery was performed in 17% of patients. The outcome was favorable in 36.67% of cases and unfavorable in 63.34% of cases. Complications included VAP (33%), pressure ulcers (30%), and urinary tract infections (23%). Overall mortality was 63.34%, with septic shock (52.6%) as the main cause. The average length of stay was 9.77 ± 12.02 days, ranging from 1 hour to 58 days. The factors for poor prognosis were a Glasgow score between 3 and 6 and a pupillary abnormality on admission. Conclusion: Severe TBI mainly affects young adult