Preditores de mortalidade e anos de vida perdidos ajustados por incapacidade (DALY) no traumatismo cranioencefálico grave em uma capital do sudeste do Brasil: um estudo observacional prospectivo
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Data
2025-08-21
Autores
Grobério, Rodrigo Miranda
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Universidade Federal do Espírito Santo
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Severe traumatic brain injury (TBI) is a highly complex clinical condition and one of the leading causes of premature death and long-term functional disability worldwide. In Brazil, the lack of region-specific studies with robust data limits the understanding of its actual magnitude, especially in understudied areas. This study aimed to identify the main predictors of mortality and estimate the burden of disease—expressed in disability-adjusted life years (DALY) —in patients with severe TBI treated at a referral hospital in the metropolitan area of Vitória, Espírito Santo. This was a prospective, observational cohort study including 737 adult patients diagnosed with severe TBI (Glasgow Coma Scale ≤ 8), conducted between May 2021 and May 2023. Clinical, sociodemographic, laboratory, and neurosurgical variables were analyzed using binary logistic regression. The burden of disease was calculated based on the sum of years of life lost due to premature death (YLL) and years lived with disability (YLD). The overall mortality rate was 52.1%, predominantly affecting young men (81.4%), with a mean age of 44.4 years. Falls from standing height were the most frequent cause of injury (32.8%). In the acute phase (up to 7 days), mortality was independently associated with decompressive craniectomy, use of vasoactive drugs, and the presence of associated trauma. In the subacute phase (8 to 112 days), intracranial pressure monitoring (ICP) and thrombocytopenia were significant predictors of death. In the chronic phase (after 113 days), age over 65 years was the main predictor. The total burden of disease was estimated at 22,322.23 DALYs over 24 months, with a mean of 30.28 DALYs per patient and 593.41 DALYs per 100,000 inhabitants/year. The findings highlight the substantial impact of severe TBI on regional public health, emphasizing the urgent need for targeted prevention, care, and rehabilitation strategies focused on high-risk populations.
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