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April 12, 2026

The Effect of Nonsurgical Critical Resuscitative Interventions on Mortality and Neurological Outcomes in Isolated Moderate-to-Severe Traumatic Brain Injury in a Resource-Limited Health System

Puntos clave

The study aims to evaluate the effectiveness of timely nonsurgical resuscitative interventions on mortality and neurological outcomes in moderate-to-severe traumatic brain injury patients in a resource-limited setting.
Cohort study involving adult trauma patients with isolated moderate-to-severe TBI from a trauma referral system
Categorization of patients based on timing of nonsurgical interventions: ≤1 h, 1–3 h, and >3 h
Assessment of mortality outcomes at 3, 7, and 30 days post-injury using Cox proportional hazard regression
21.7% of patients died within 3 days; 27.6% within 7 days; 31.2% within 30 days.
A 26% reduction in 7-day mortality was observed in patients receiving interventions ≤1 h compared to those >3 h (HR = 0.74).
Among patients with blunt injuries, there was a 21% mortality benefit (HR = 0.79) for timely interventions.

Resumen

Traumatic brain injury (TBI) accounts for approximately 2.5 million deaths yearly, with patients living in low- and middle-income countries disproportionally affected. Nonsurgical critical resuscitation interventions (nsCRIs) studied individually have been shown to improve outcomes in moderate-to-severe TBI (msTBI) patients. This cohort study primarily assesses the relationship between timeliness of delivery of grouped nsCRIs and all-cause 7-day mortality among blunt and/or penetrating isolated msTBI patients, with secondary objectives of 3- and 30-day mortality and discharge Glasgow Coma Scale (GCS). Adult trauma patients with isolated msTBI from January 2022 to December 2024 were enrolled from facilities in a trauma referral pathway in the Western Cape of South Africa. Cohort patients were categorized into treatment subgroups of those receiving nsCRI ≤1 h or nsCRI within 1–3 h; the reference group was receiving nsCRI >3 h from injury or missed nsCRIs. Inverse probability weighted Cox proportional hazard regression was used to model mortality outcome. Subgroup and sensitivity analyses were performed. Of the 507 patients within the cohort, 68.6% of patients had blunt injuries, and one-half had severe TBI. 21.7% of all msTBI patients died within 3 days, 27.6% deceased by 7 days, and 31.2% deceased within 30 days. There was a 26% (hazard ratio HR = 0.74; 95% confidence interval CI: 0.56, 0.98) 7-day mortality reduction among patients who received nsCRIs ≤1 h compared with the reference group. The subgroup of blunt and blunt with penetrating injured patients showed a 21% 7-day mortality benefit (HR = 0.79, 95% CI: 0.71, 0.88) and better discharge GCS categories among patients receiving timely nsCRIs (odds ratio = 1.79; 95% CI: 1.01, 3.19). Among severe TBI patients, there was a 29% 7-day mortality reduction in the nsCRI ≤1 h compared with >3 h or missed nsCRI (HR = 0.71, 95% CI: 0.5, 1.00). While those statistically significant subgroup findings should be interpreted with caution and several subgroup analyses did not show statistical significance, there was an overall trend towards survival benefit associated with nsCRIs at either ≤1 h and/or 1–3 h. Overall, in this cohort study of msTBI patients receiving care in a resource-limited trauma system, we found that nsCRIs delivered within 3 h were associated with improved 7-day mortality and neurological outcomes at discharge.

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Cite This Study

Dymond et al. (Fri,) studied this question.

synapsesocial.com/papers/69db37ca4fe01fead37c5e5b https://doi.org/https://doi.org/10.1177/08977151261427265

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