Mortality Among Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
- 1Kampala International University - Western Campus
Abstract
BackgroundSevere traumatic brain injury (TBI) is a leading cause of trauma death, yet reported mortality varies widely. We estimated the pooled mortality of severe TBI and explored sources of variation.
MethodsWe searched PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library and Google Scholar from inception to January 2026 (PROSPERO CRD420261417287). Observational and interventional studies reporting the number of deaths among patients with severe TBI (Glasgow Coma Scale [GCS] [≤]8) were eligible. Two reviewers independently selected studies, extracted data and assessed risk of bias with the Newcastle-Ottawa Scale. Logit-transformed proportions were pooled with a DerSimonian-Laird random-effects model; we report 95% confidence intervals (CI) and 95% prediction intervals (PI). Heterogeneity was explored by subgroup analysis, meta-regression and pre-specified sensitivity analyses, and certainty was rated with GRADE for prognosis.
ResultsTwenty-four studies (11,544 patients; 5,234 deaths) from 15 countries, published 2001-2024, were included. Study-level mortality ranged from 18.2% to 71.1%. Pooled mortality was 40.9% (95% CI 35.7-46.3%; I{superscript 2} = 96.3%), with a 95% PI of 18.9-67.2%. Mortality differed by region (p = 0.002): 47.1% (37.6-56.8%) in Africa, 44.5% (40.2-48.8%) in Europe, 38.6% (25.4-53.7%) in Asia and 31.6% (26.5-37.2%) in the Americas. Mortality did not differ significantly by country income group, outcome time point, age group or publication year. Estimates were robust to alternative random-effects estimators, leave-one-out analysis (range 39.6-41.7%) and restriction to studies with independently verified counts (41.7%) or low risk of bias (38.4%). Certainty of evidence was low.
ConclusionsApproximately two in five patients with severe TBI die, but the wide prediction interval shows that the expected mortality in any single setting may lie anywhere between roughly one in five and two in three. Mortality was highest in African cohorts. Standardised definitions, outcome time points and reporting are needed to allow meaningful comparison across trauma systems.
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BibTeX
@misc{ruhazwe2026mortality,
title = {{Mortality Among Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis}},
author = {F. J. Ruhazwe and B. Mumbere and M. Michael and T. Hakizimana and O. Elna},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.12.26365294},
url = {https://www.medrxiv.org/content/10.64898/2026.10.12.26365294v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Mortality Among Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
AU - F. J. Ruhazwe
AU - B. Mumbere
AU - M. Michael
AU - T. Hakizimana
AU - O. Elna
PY - 2026
DA - 2026/10/12
PB - medRxiv
DO - 10.64898/2026.10.12.26365294
UR - https://www.medrxiv.org/content/10.64898/2026.10.12.26365294v1
AB - BackgroundSevere traumatic brain injury (TBI) is a leading cause of trauma death, yet reported mortality varies widely. We estimated the pooled mortality of severe TBI and explored sources of variation. MethodsWe searched PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library and Google Scholar from inception to January 2026 (PROSPERO CRD420261417287). Observational and interventional studies reporting the number of deaths among patients with severe TBI (Glasgow Coma Scale [GCS] [≤]8) were eligible. Two reviewers independently selected studies, extracted data and assessed risk of bias with the Newcastle-Ottawa Scale. Logit-transformed proportions were pooled with a DerSimonian-Laird random-effects model; we report 95% confidence intervals (CI) and 95% prediction intervals (PI). Heterogeneity was explored by subgroup analysis, meta-regression and pre-specified sensitivity analyses, and certainty was rated with GRADE for prognosis. ResultsTwenty-four studies (11,544 patients; 5,234 deaths) from 15 countries, published 2001-2024, were included. Study-level mortality ranged from 18.2% to 71.1%. Pooled mortality was 40.9% (95% CI 35.7-46.3%; I{superscript 2} = 96.3%), with a 95% PI of 18.9-67.2%. Mortality differed by region (p = 0.002): 47.1% (37.6-56.8%) in Africa, 44.5% (40.2-48.8%) in Europe, 38.6% (25.4-53.7%) in Asia and 31.6% (26.5-37.2%) in the Americas. Mortality did not differ significantly by country income group, outcome time point, age group or publication year. Estimates were robust to alternative random-effects estimators, leave-one-out analysis (range 39.6-41.7%) and restriction to studies with independently verified counts (41.7%) or low risk of bias (38.4%). Certainty of evidence was low. ConclusionsApproximately two in five patients with severe TBI die, but the wide prediction interval shows that the expected mortality in any single setting may lie anywhere between roughly one in five and two in three. Mortality was highest in African cohorts. Standardised definitions, outcome time points and reporting are needed to allow meaningful comparison across trauma systems.
ER -