Characteristics and Outcomes of Thai Patients
Hospitalized with Severe Traumatic Brain
Injury between 2009 and 2011
Sumidtra Prathep MD*1, Hutcha Sriplung MD*2, Nakornchai Phuenpathom MD*3,
Joseph Zunt MD, MPH*4, Siriporn Hirunpat MD*5, Monica S Vavilala MD*6
Affiliation :
*1 International Fogarty Fellow, Department of Anesthesiology, Faculty of Medicine,
Prince of Songkla University, Songkhla, Thailand
*2 Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*3 Department of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*4 Departments of Global Health and Neurology, University of Washington, Seattle, Washington, United States
*5 Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*6 Departments of Anesthesiology and Pediatrics, Harborview Injury Prevention and Research Center,
University of Washington, Seattle, Washington, United States
Objective : To describe the characteristics and outcomes of Thai patients who suffer from severe traumatic brain injury
(TBI).
Material and Method: We examined the clinical characteristics and outcomes of a cohort of severe TBI patients receiving
care at Songklanagarind Hospital, Thailand between January 1, 2009 and December 31, 2011. Using a modified version
of the National Institutes of Neurological Diseases and Stroke Common Data Elements, we abstracted medical record data
on demographics, hospital course, and outcomes (mortality and Glasgow Outcome Scale [GOS]). Inclusion criteria were
history of trauma, traumatic head computed tomography finding, age 18 years and older, admission Glasgow Coma Scale
score less than 9, head Abbreviated Injury Score of 3 or greater, and tracheal intubation in the intensive care unit. GOS 4
or 5 reflects favorable outcome.
Results : Data from 200 patients (27.4% of hospitalized TBI) were reviewed. Median age was 34±1.2 years and most (80.5%,
n = 161) were male. The most common mechanism of injury was motorcycle collision (65.5%, n = 131). Most patients (110,
55%) were transported to hospital by a vehicle managed by a non-profit organization. Computerized head tomography
showed subdural hematoma in 105 (52.5%), subarachnoid hemorrhage in 93 (46.5%), contusion in 47 (23.5%), and midline
shift in four (23.5%) patients. Blood alcohol was positive in over 50% and 62.5% had polytrauma. Discharge mortality
was 17% (n = 34) and discharge GOS was 4±1. Three, 6, and 12 months GOS among patients with follow-up were 4±0.1
(n = 71/200), 5±0.2, (n = 48/200), and 5±0.2 (n = 30/200), respectively.
Conclusion : The proportion of trauma patients hospitalized with severe TBI is high. Most patients with TBI have multiple
trauma, and in-patient mortality is high. Blood alcohol level may contribute to the high TBI burden. Fewer than 50% of
severe TBI patients received follow-up care at the trauma center.
Keywords : Adherence, Guideline, Traumatic brain injury
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