Clinical Characteristics and Outcomes of Traumatic Brain Injury in a High-Volume Tertiary Care Center in India: A Prospective Observational Cohort Study.

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a major public health challenge in India but there is a lack of high-quality data on its clinical characteristics and outcomes. We aimed to describe the TBI population of a tertiary care center in India, identify predictors of inpatient mortality, and assess the performance of existing prognostic tools. METHODS: We conducted a prospective observational cohort study of patients admitted to a high-volume tertiary care center in Vellore, India, after a TBI between 2013 and 2019. RESULTS: We identified 3172 patients (2667 males, 84%) admitted after a TBI (median age = 34 years [IQR 23-48]). Two-wheeler road traffic accidents caused 2259 (71%) injuries, in which 13 (0.6%) patients were wearing a helmet. There were 174 (5%) inpatient deaths (median length of stay = 6 days [IQR 4-10]) and overall mortality (median follow-up = 6 months [IQR 3-9]) was 17% (n = 540). Age, Glasgow Coma Scale motor score, systolic blood pressure ≤90 mm Hg, and key computed tomography imaging features were independently associated with inpatient mortality. Existing prognostic models predicted inpatient mortality with good performance (International Mission for Prognosis and Analysis of Clinical Trials in TBI: Brier = 0.0876, area under the curve (AUC) = 83% [95% CI 79%-87%]; Rotterdam CT: Brier = 0.0890, AUC 79% [95% CI 75%-83%]), but showed poorer performance for post-discharge mortality (International Mission for Prognosis and Analysis of Clinical Trials in TBI: Brier = 0.134, AUC = 75% [95% CI 72%-78%]; Rotterdam CT: Brier = 0.145, AUC 66% [95% CI 63%-69%]). CONCLUSION: In a tertiary care center in India, we described a predominantly young male TBI population with a high contribution of 2-wheeler road traffic accidents and significant post-discharge mortality. Existing prognostic models showed poor performance when predicting which patients died after discharge. These findings should inform public health interventions to reduce the significant burden of TBI in India.