Traumatic brain injury outcomes and mortality predictors in Eastern India: An observational study

Title: Traumatic brain injury outcomes and mortality predictors in Eastern India: A prospective observational cohort study Objective: To evaluate clinical outcomes and identify predictors of mortality in patients with traumatic brain injury treated at a tertiary trauma centre in Eastern India. Methods: This was a single-centre prospective observational cohort study conducted at AIIMS, Patna, Bihar, Eastern India, over 18 months (July 2023–January 2025). A total of 383 consecutive patients with traumatic brain injury were enrolled based on predefined inclusion and exclusion criteria. Demographic, clinical, radiological, and management variables were recorded. Functional outcomes were assessed at discharge, 3 months, 6 months months using the Glasgow Outcome Scale-Extended. Logistic regression was used to identify independent predictors of mortality and poor functional outcome. Results: The mean age was 34.4 ± 15.2 years, and most patients were male (68.9%). Road traffic accidents were the leading cause of injury (68.9%). Based on admission Glasgow Coma Scale, 53.3% had mild, 20.1% moderate, and 26.6% severe traumatic brain injury. Mortality was 23.5% at discharge and 24.5% at 6 months, with 95.7% of deaths occurring within the first month. Favourable outcomes (Glasgow Outcome Scale-Extended 6–8) were observed in 66.1% at 3 months and 70.8% at 6 months. Severe traumatic brain injury was significantly associated with 6-month mortality ( p < 0.001) and poor outcomes ( p < 0.001). Radiological features associated with mortality included intraventricular haemorrhage ( p = 0.011), midline shift ( p = 0.019), third ventricle obliteration ( p = 0.023), sulcal effacement ( p = 0.028), and cisternal collapse ( p = 0.017). Multivariate analysis confirmed older age, lower Glasgow Coma Scale, abnormal pupillary reflex, intraventricular haemorrhage, and sulcal effacement as independent predictors of 6-month mortality. Among management strategies, burr-hole surgery yielded the best functional recovery (93.3%), while craniectomy was associated with the highest mortality (45.0%). Conclusions: Traumatic brain injury in Eastern India predominantly affects young males in road traffic accidents. While functional recovery appeared to improve between discharge and 6 months, severe injuries and specific radiological features may be associated with increased mortality. Burr-hole surgery and craniotomy may be linked to more favourable outcomes compared with craniectomy. Strengthening trauma systems and timely surgical interventions may help improve outcomes in resource-limited settings.