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