Demographics and mortality outcomes of neurotrauma in guatemala city

Background: In Guatemala, trauma is the leading cause of productive years of life lost and the fourth leading cause of death, but no published data is available on the incidence of neurotrauma. This study was conducted to obtain basic demographic information on traumatic brain injury (TBI) patients at the second highest-volume hospital in the country; determine whether TBI severity and other demographic variables correlated to poor outcomes; and place this information in the context of neurotrauma worldwide. Methods: Case series study of TBI patients who were admitted to Hospital General San Juan de Dios in Guatemala City, Guatemala from May 2013-April 2015. Data was collected from nursing logs in the hospital's trauma bay and reports submitted to the Ministry of Health. Age, gender, and severity of TBI were compared to hospital length of stay (LOS) and in-hospital mortality. TBI severity was graded as mild (GCS=13-15), moderate (GCI=9-12), and severe (GCI=3-8). Findings: 360 patients aged 15-91 years were included. The mean age was 39.2 years (SD=18.4). Patients were predominantly male (n=310, 86.1%). 119 patients (33.1%) received a TBI diagnosis of mild, 105 (29.2%) moderate, and 136 (37.8%) severe. Men were more likely to receive a severe TBI diagnosis (p=0.006, 40.3% men vs. 22.0% women). Overall mortality rate from TBI was 43.9% (n=158). Mortality rates increased with age (p=0.002) and severity grading (p<0.001). Mortality rates for mild, moderate, and severe grading were 21.0% (n=25), 41.0% (n=43), and 66.2% (n=90), respectively. Demographic variables, however, did not affect hospital length of stay (R2=0.00044). The median LOS was six days; most patients were discharged within one day (n=86, 23.9%). Interpretation: Neurotrauma in Guatemala is linked to significantly higher mortality than in comparable countries. A 2009 study examining TBI outcomes in 46 countries participating in the CRASH trial found similar patient demographics but a mortality rate of 26.2% in other lower-middle income countries. Hospital length of stay is unaffected e likely due to the resource paucity for post-injury treatment in this environment. This study was limited by lack of access to numerical GCS scores, mechanism of injury, neuro-imaging, and treatment data. It highlights, however, the need for further data collection on TBI patients.