Time to mortality and its predictors among traumatic brain injury patients admitted to Hiwot Fana Comprehensive Specialized University Hospital, Harari Region, Eastern Ethiopia: a hospital based, retrospective follow-up study

Traumatic brain injury (TBI) is a significant issue worldwide, causing many deaths and disabilities. It is essential to know when people are most at risk of dying and what factors contribute to this risk, especially in countries that are still developing. Ethiopia faces additional challenges due to its limited healthcare resources and infrastructure, which worsen the burden. The aim of this study was to assess the magnitude of mortality, time to mortality and its predictors among traumatic brain injury patients admitted to Hiwot Fana Specialized Comprehensive University Hospital, Eastern Ethiopia, from January 1, 2020, to December 31, 2024. This hospital-based retrospective follow-up study included the medical records of 322 patients diagnosed with mild, moderate, or severe traumatic brain injury (TBI) who were admitted to Hiwot Fana Comprehensive Specialized University Hospital in the Harari region of Eastern Ethiopia. A simple random sampling method was utilized to select study participants. SPSS version 26 was used for data analysis. The Kaplan–Meier method was used to estimate the survival function and overall median survival time to mortality. Multi-level Cox proportional hazards regression model was used to determine predictors of time to mortality at a statistically significant level of p values less than 0.05 with a 95% confidence interval. A total of 322 traumatic brain injury patients who were admitted to Hiwot Fana Comprehensive Specialized University Hospital were included. The overall median time to mortality was 13 days (95% CI: 11.46–14.54). The significantly associated predictors with time to mortality included the absence of abnormal body movement (AHR = 0.253, 95% CI: 0.105–0.611), brain hemorrhage (AHR = 3.730, 95% CI: 1.244–11.178), reduced muscle strength (e.g., 0/5 power: AHR = 10.407, 95% CI: 2.236–48.438), and conservative management (AHR = 14.724, 95% CI: 2.648–81.882). This study revealed that most of the deaths among TBI patients occurred in the early weeks after admission. Survival was significantly influenced by early clinical factors, imaging findings, and access to surgical care. Improving early triage, strengthening surgical capacity, and utilizing clinical and imaging predictors for risk stratification are crucial to improving survival outcomes in TBI patients.