JGNAHS
14J Gandhara Nurs Alli Health SciJanuary - June 2025
:
:
https://doi.org/10.37762/jgnahs.144
FACTORS ASSOCIATED WITH TRAUMATIC BRAIN INJURY IN PATIENTS PRESENTING TO
INTENSIVE CARE UNIT OF HAYATABAD MEDICAL COMPLEX PESHAWAR, PAKISTAN
Zabih Ullah1, Maham Qazi2
How to cite this article
Ullah Z, Qazi M. Factors Associated
with Traumatic Brain Injury in
Patients Presenting To Intensive Care
Unit of Hayatabad Medical Complex
Peshawar, Pakistan. J Gandhara Nurs
Alli Health Sci. 2025;5(1):14-19
Date of Submission:
Date Revised:
Date Acceptance:
1Lecturer Emergency and Intensive
Care Technology, Faculty of Allied
Health Science Superior University,
Lahore
Correspondence
2Maham Qazi, Assistant Professor
Azra Naheed Medical college, Faculty
of Allied Health Sciences Superior
University, Lahore
+92-333-9190005
mhmqazi@gmail.com
ABSTRACT
OBJECTIVES
This study aimed to investigate the correlation between falls, motor vehicle
accidents, and sports-related injuries with occurrences of traumatic brain
injury. Additionally, the research aimed to examine the relationships among
age, gender, and occupational factors in traumatic brain injury.
METHODOLOGY
A cross-sectional study was conducted in the intensive care unit of Hayatabad
Medical Complex in Peshawar. A purposive sampling technique,
accompanied by a structured questionnaire, was employed to collect data.
The Chi-square test was applied with the type of group (CT scan findings of
TBI) as the outcome variable, while all other independent variables were
considered. Data analysis was performed using SPSS version 22.
RESULTS
Most patients with extradural hematoma were male (29, 24.6%, p-value
0.59), primarily aged 15-29, with 16 (33.3%, p-value 0.09) identified as
students. Notably, road traffic accidents affected 21 patients (30.4%, p -value
0.03), mainly in the frontal brain area. Vital signs showed 21 patients
(28.0%, p-value 0.88) with low blood pressure and 25 (36.8%, p-value 0.08)
with low respiratory rates. Most had a GCS score below 8 (25 patients,
30.9%, p-value 0.20), with many (44 patients, 32.6%, p-value 0.007) having
reactive pupils and no prior alcohol use. Additionally, 45 patients (27.3%, p-
value 0.02) were not wearing protective gear, 40 (31.3%, p-value 0.17)
reported headaches and dizziness, 27 patients (42.9%, p-value 0.10) took
over 90 minutes to seek care, and 33 patients with multiple findings (35.9%,
p-value 0.009) required invasive ventilation.
CONCLUSION
TBI was common in males who had a history of road traffic accidents and
their CT scan finding shows most of the patients had extradural Hematoma
with severe traumatic brain injury.
KEYWORDS: Traumatic Brain Injury, Glasgow Coma Scale, Extradural
Hematoma, Computed Tomography
INTRODUCTION
Injury is one of the top five causes of mortality and
disability worldwide, making it a serious public health
concern.1 Traumatic brain injury (TBI) is the primary
cause of mortality, disability, and cognitive impairment
in young people globally.2 The term "alteration in brain
function or other evidence of brain pathology, caused
by an external force" refers to traumatic brain injury
(TBI).3 Traumatic brain injury (TBI) is a non-
congenital brain injury caused by an external
mechanical force that can affect cognitive, physical,
and psychosocial abilities either permanently or
temporarily. Around the world, traumatic brain injury
(TBI) is a significant cause of death and disability for
people of all ages. The burden of TBI is highest in low-
and middle-income countries (LMICs) because these
nations have high rates of risk factors and inadequate
health systems for providing both acute and long-term
care. The increased usage of motor vehicles, especially
in developing countries, is leading to an increase in the
incidence of traumatic brain injury (TBI), which is on
the rise globally. The increasing usage of motor
vehicles, physical assault, and violence are contributing
factors to the global rise in TBI incidence. Among
young people, traumatic brain injury is a common
cause of mortality and disability. Traffic accidents,
falls, physical attack, violence, and explosion and
gunshot injuries are the most common causes of
traumatic brain injury (TBI). Patients often experience
altered consciousness, focal neurological impairments,
headaches, nausea, and confusion right after a
traumatic brain injury. The American Congress of
Rehabilitation Medicine defines a traumatic brain
injury (TBI) as any change in mental state that occurs
at the moment of an accident. After studying wounded
troops in World War II, Alexander Luria focused his
rehabilitation efforts on focal brain injury and its
ORIGINAL ARTICLE
05-11-2024
13-01-2025
14-01-2025
JGNAHS
15 J Gandhara Nurs Alli Health Sci January - June 2025
effects on language, motor skills, and cognition. A
traumatic brain injury is classified as mild if the GCS
score is between 13 and 15, as moderate if it is between
9 and 12, and as severe if it is 8 or lower.4 According to
a retrospective study carried out at eight level 1 trauma
centres in the western United States, the patients
admitted to ICU were only 5% their GCS score was 15
and they had mild TBI.5 About 25% of patients with
traumatic brain injuries who are hospitalized in
hospitals pass away within six months of the accident.6
Worldwide, traumatic brain injuries (TBIs) affect about
50 million individuals annually, and half of all people
are expected to experience one or more TBIs in their
lifetime.7 The inaugural Lancet Neurology Commission
on TBI emphasized the massive public health burden
caused by TBI.8 According to the World Health
Organization’s (WHO) global burden of injury
estimation, injuries are among the top ten causes of
mortality globally. Among them, TBI is responsible for
about 30% of injury-related fatalities and is the main
cause of death and disability. Traumatic brain injury
(TBI) is the leading cause of mortality and disability in
the United States of America (USA).9 More than 2.8
million TBI cases were reported annually, with a 2%
fatality rate(10). Over the past forty years,
advancements in intensive care unit (ICU) and
prehospital resuscitation have reduced mortality by
12% and raised positive outcomes by 6%,
respectively.2 There is evidence linking the quality of
life (QOL) of TBI survivors to demographic variables
such as age, marital status, and occupational status. A
new study that included 337 adult TBI patients looked
at community integration and quality of life from one
to more than twenty years following the injury. The
findings showed a strong connection between
perceived QOL and employment. Individuals with full-
or part-time employment reported greater quality of life
scores than those without employment.11 At roughly
three years after the injury, 25 interviews were
performed with nine TBI participants and sixteen
closes-others (CO) of TBI participants (note: These
close relatives of 16 other TBI participants were their
spouses or other family members) the primary leading
factor for injury was car accident (40%) and was
followed by falls (16%), pedestrian collisions (16%),
motorcycle crashes (12%), assaults (12%), and other
sources (4%).12 The TBI severeness was defined as a
GCS score of 3-8 and was considered severe in 2804
(21%) cases, moderate (GCS score of 9-12) in 2930
(22%) cases, and mild (GCS 13-15) in 7404 (56%)
cases. The average GCS score was 13.13 A record of
the mechanism of injury was kept for 329 individuals.
Among the 329 patients, attack with a stick accounted
for 124 cases, or 37.7% of all injuries. 64 patients
(19.5%) suffered from falls, whereas 103 patients
(31.3%) had head injuries as a result of RTAs. Of the
victims of RTAs, 24 (23.3%) were car occupants and
46 (44.7%) were pedestrians. Patients vital signs were
evaluated per how they arrived. 50 (34.7%) of the 144
patients who arrived by ambulance and had
documented vital signs had low blood pressure or low
oxygen saturation. From the patient charts, computed
tomography (CT) results for 320 individuals were
obtained. The primary finding from which the patients’
treatment plans were developed was the basis for
recording the CT findings. In most cases, depressed
skull vault fractures (DSFs) were noticed. 51 patients
(15.9%) developed acute epidural hematoma (AEDH),
while 94 patients (29.4%) had DSFs. 42 patients
(13.1%) had a chronic subdural hematoma.
12 individuals (3.8%) experienced an acute subdural
hematoma. Of the patients, 38 (11.9%) had
contusions.14 To identify the most common associated
factors of head injuries such as falls, sports injuries and
car accidents to inform prevention strategies and to
reduce the relevant disease burden in the community.
The objective of the study is to determine the
association of falls, motor vehicle accidents and sports
injuries with Traumatic brain injury, and to find the
association of age, gender and occupation with
Traumatic brain injury.
METHODOLOGY
This cross-sectional study was carried out at Hayatabad
Medical Complex (HMC) in Peshawar, where all the
patients suffering from Traumatic brain injury in the
intensive care unit of Hayatabad Medical Complex
were selected. Using Open Epi an online tool for
sample size calculations, the total sample size was 174
with an anticipated frequency of 13% by keeping 95%
confidence interval and 4% margin of error. A
purposive non-probability sampling technique was
used. Selected patients were admitted to the intensive
care unit (ICU) for Traumatic brain injury in
Hayatabad Medical Complex, Peshawar. Written and
oral consent was taken from the attendants of the
selected patients. They were guided for the study
objectives and confidentiality of the data. Inclusion and
exclusion criteria were strictly followed to avoid
biases. An ethical approval (Approval No: 1989) was
taken from the ethical committee of Hayatabad
Medical Complex (HMC) Peshawar, Pakistan. SPSS
version 22 was used for data analysis. Numerical
variables were presented in the form of mean and
standard deviation while categorical variables were
presented in the form of frequency and percentages.
Chi-square tests were applied by taking the type of
group (CT scan finding of TBI) as the outcome
variable with all other independent variables. A
significant p-value of < 0.05 was taken as significant.
Factors Associated with Traumatic Brain Injury in Patients
15 J Gandhara Nurs Alli Health Sci January - June 2025
effects on language, motor skills, and cognition. A
traumatic brain injury is classified as mild if the GCS
score is between 13 and 15, as moderate if it is between
9 and 12, and as severe if it is 8 or lower.4 According to
a retrospective study carried out at eight level 1 trauma
centres in the western United States, the patients
admitted to ICU were only 5% their GCS score was 15
and they had mild TBI.5 About 25% of patients with
traumatic brain injuries who are hospitalized in
hospitals pass away within six months of the accident.6
Worldwide, traumatic brain injuries (TBIs) affect about
50 million individuals annually, and half of all people
are expected to experience one or more TBIs in their
lifetime.7 The inaugural Lancet Neurology Commission
on TBI emphasized the massive public health burden
caused by TBI.8 According to the World Health
Organization’s (WHO) global burden of injury
estimation, injuries are among the top ten causes of
mortality globally. Among them, TBI is responsible for
about 30% of injury-related fatalities and is the main
cause of death and disability. Traumatic brain injury
(TBI) is the leading cause of mortality and disability in
the United States of America (USA).9 More than 2.8
million TBI cases were reported annually, with a 2%
fatality rate(10). Over the past forty years,
advancements in intensive care unit (ICU) and
prehospital resuscitation have reduced mortality by
12% and raised positive outcomes by 6%,
respectively.2 There is evidence linking the quality of
life (QOL) of TBI survivors to demographic variables
such as age, marital status, and occupational status. A
new study that included 337 adult TBI patients looked
at community integration and quality of life from one
to more than twenty years following the injury. The
findings showed a strong connection between
perceived QOL and employment. Individuals with full-
or part-time employment reported greater quality of life
scores than those without employment.11 At roughly
three years after the injury, 25 interviews were
performed with nine TBI participants and sixteen
closes-others (CO) of TBI participants (note: These
close relatives of 16 other TBI participants were their
spouses or other family members) the primary leading
factor for injury was car accident (40%) and was
followed by falls (16%), pedestrian collisions (16%),
motorcycle crashes (12%), assaults (12%), and other
sources (4%).12 The TBI severeness was defined as a
GCS score of 3-8 and was considered severe in 2804
(21%) cases, moderate (GCS score of 9-12) in 2930
(22%) cases, and mild (GCS 13-15) in 7404 (56%)
cases. The average GCS score was 13.13 A record of
the mechanism of injury was kept for 329 individuals.
Among the 329 patients, attack with a stick accounted
for 124 cases, or 37.7% of all injuries. 64 patients
(19.5%) suffered from falls, whereas 103 patients
(31.3%) had head injuries as a result of RTAs. Of the
victims of RTAs, 24 (23.3%) were car occupants and
46 (44.7%) were pedestrians. Patients vital signs were
evaluated per how they arrived. 50 (34.7%) of the 144
patients who arrived by ambulance and had
documented vital signs had low blood pressure or low
oxygen saturation. From the patient charts, computed
tomography (CT) results for 320 individuals were
obtained. The primary finding from which the patients’
treatment plans were developed was the basis for
recording the CT findings. In most cases, depressed
skull vault fractures (DSFs) were noticed. 51 patients
(15.9%) developed acute epidural hematoma (AEDH),
while 94 patients (29.4%) had DSFs. 42 patients
(13.1%) had a chronic subdural hematoma.
12 individuals (3.8%) experienced an acute subdural
hematoma. Of the patients, 38 (11.9%) had
contusions.14 To identify the most common associated
factors of head injuries such as falls, sports injuries and
car accidents to inform prevention strategies and to
reduce the relevant disease burden in the community.
The objective of the study is to determine the
association of falls, motor vehicle accidents and sports
injuries with Traumatic brain injury, and to find the
association of age, gender and occupation with
Traumatic brain injury.
METHODOLOGY
This cross-sectional study was carried out at Hayatabad
Medical Complex (HMC) in Peshawar, where all the
patients suffering from Traumatic brain injury in the
intensive care unit of Hayatabad Medical Complex
were selected. Using Open Epi an online tool for
sample size calculations, the total sample size was 174
with an anticipated frequency of 13% by keeping 95%
confidence interval and 4% margin of error. A
purposive non-probability sampling technique was
used. Selected patients were admitted to the intensive
care unit (ICU) for Traumatic brain injury in
Hayatabad Medical Complex, Peshawar. Written and
oral consent was taken from the attendants of the
selected patients. They were guided for the study
objectives and confidentiality of the data. Inclusion and
exclusion criteria were strictly followed to avoid
biases. An ethical approval (Approval No: 1989) was
taken from the ethical committee of Hayatabad
Medical Complex (HMC) Peshawar, Pakistan. SPSS
version 22 was used for data analysis. Numerical
variables were presented in the form of mean and
standard deviation while categorical variables were
presented in the form of frequency and percentages.
Chi-square tests were applied by taking the type of
group (CT scan finding of TBI) as the outcome
variable with all other independent variables. A
significant p-value of < 0.05 was taken as significant.
Factors Associated with Traumatic Brain Injury in Patients
16J Gandhara Nurs Alli Health Sci
JGNAHS
January - June 2025
RESULTS
Table 1a: Descriptive Statistic of a Categorical Variable
Factors Associated with Traumatic Brain Injury in Patients
Variable Categories Frequency %age
Age of the patient in categories
15-29 80 46
30-44 59 33.9
45-59 22 12.6
60-74 12 6.9
>74 01 0.6
Gender
Male 118 67.8
Female 54 31
Transgender 02 1.1
Occupation
Housewife 42 24.1
Teacher 13 7.5
Student 48 27.6
Healthcare worker 07 4.0
Labour 34 19.5
Business 27 13.2
Other 07 4.0
Injury Pattern
Road traffic accident 69 39.7
History of fall 49 28.2
Sport injury 16 9.2
Blast injury 02 1.1
Assault 15 8.6
Being stuck by an object 15 8.6
Other 08 4.6
Location of Injury
Frontal 44 25.3
Temporal 27 15.5
Parietal 23 13.2
Occipital 34 19.5
Multiple locations 46 26.4
CT Scan Finding of TBI
Subdural Hematoma 24 13.8
Extradural Hematoma 46 26.4
Subarachnoid Hemorrhage 23 13.2
Cerebral Contusion 37 21.3
Multiple finding 44 25.3
GCS Score or Severity of Injury
Mild 22 12.6
Moderate 71 40.8
Severe 81 46.6
Alcohol Use before Injury Yes 07 4.0
No 167 96
Use of Protective Gear, Helmet or Seatbelt at The
Time of Injury
Yes 09 5.2
No 165 94.8
Table 1b: Descriptive Tables for Continuous Variable
Variable Mean
Age in years 32.86
Total household income 52040.23
Time taken to reach initial health care setting after injury 159.41
Standard deviation Min-Max
14.11 15-75
40064.30 10000-300000
263.19 5-2040
JGNAHS
January - June 2025
RESULTS
Table 1a: Descriptive Statistic of a Categorical Variable
Factors Associated with Traumatic Brain Injury in Patients
Variable Categories Frequency %age
Age of the patient in categories
15-29 80 46
30-44 59 33.9
45-59 22 12.6
60-74 12 6.9
>74 01 0.6
Gender
Male 118 67.8
Female 54 31
Transgender 02 1.1
Occupation
Housewife 42 24.1
Teacher 13 7.5
Student 48 27.6
Healthcare worker 07 4.0
Labour 34 19.5
Business 27 13.2
Other 07 4.0
Injury Pattern
Road traffic accident 69 39.7
History of fall 49 28.2
Sport injury 16 9.2
Blast injury 02 1.1
Assault 15 8.6
Being stuck by an object 15 8.6
Other 08 4.6
Location of Injury
Frontal 44 25.3
Temporal 27 15.5
Parietal 23 13.2
Occipital 34 19.5
Multiple locations 46 26.4
CT Scan Finding of TBI
Subdural Hematoma 24 13.8
Extradural Hematoma 46 26.4
Subarachnoid Hemorrhage 23 13.2
Cerebral Contusion 37 21.3
Multiple finding 44 25.3
GCS Score or Severity of Injury
Mild 22 12.6
Moderate 71 40.8
Severe 81 46.6
Alcohol Use before Injury Yes 07 4.0
No 167 96
Use of Protective Gear, Helmet or Seatbelt at The
Time of Injury
Yes 09 5.2
No 165 94.8
Table 1b: Descriptive Tables for Continuous Variable
Variable Mean
Age in years 32.86
Total household income 52040.23
Time taken to reach initial health care setting after injury 159.41
Standard deviation Min-Max
14.11 15-75
40064.30 10000-300000
263.19 5-2040
JGNAHS
17 J Gandhara Nurs Alli Health Sci January - June 2025
Table 2: Comparison of different CT scan findings of TBI with other associated factors
Variable Categories Subdural
Hematoma
Extradural
Hematoma
Subarachnoid
Hemorrhage
Cerebral
contusion
Multiple
finding
P-
Value
Age
15-29 11(13.8%) 24(30.0%) 07(8.8%) 19(23.8%) 19(23.8%)
0.69
30-44 08(13.6%) 14(23.7%) 08(13.6%) 11(18.6%) 18(30.5%)
45-59 02( 9.1%) 07(31.8%) 05(22.7%) 04(18.2%) 04(18.2%)
60-74 03(25.0%) 01(08.3%) 03(25.0%) 03(25.0%) 02(16.7%)
>74 0(00.0%) 0(00.0%) 0(00.0%) 0(00.0%) 01(100.0%)
Gender
Male 16(13.6%) 29(24.6%) 19(16.1%) 25(21.2%) 29(24.6%)
0.59Female 07(13.0%) 17(31.5%) 04(07.4%) 12(22.2%) 14(25.9%)
Transgender 01(50.0%) 0(00.0%) 0(00.0%) 0(00.0%) 01(50.0%)
How did the injury
occur
RTA 08(11.6%) 21(30.4%) 07(10.1%) 14(20.3%) 19(27.5%)
0.03
History of fall 07(14.3%) 18(36.7% 07(14.3%) 09(18.4%) 08(16.3%)
Sport injury 03(18.8%) 02(12.5%) 01(6.3%) 03(18.8%) 07(43.8%)
Blast injury due to
explosion 01(50.0%) 0(00.0%) 01(50.0%) 0(00.0%) 0(00.0%)
Assault 04(26.7%) 0(00.0%) 01(6.7%) 05(33.3%) 05(33.3%)
Being stuck by an
object 01(6.7%) 04(26.7%) 04(26.7%) 01(6.7%) 05(33.3%)
Other 0(00.0%) 01(12.5%) 02(25.0%) 05(62.5%) 0(00.0%)
Location of injury
Frontal 06(13.6%) 14(31.8%) 03(6.8%) 13(29.5%) 08(18.2%)
0.13
Temporal 05(18.5%) 10(37.0%) 04(14.8%) 02(7.4%) 06(22.2%)
Parietal 04(17.4%) 07(30.4%) 04(17.4%) 05(21.7%) 03(13.0%)
Occipital 06(17.6%) 07(20.6%) 07(20.6%) 07(20.6%) 07(20.6%)
Multiple locations 03(6.5%) 08(17.4%) 05(10.9%) 10(21.7%) 20(43.5%)
High 03(10.0%) 05(16.7%) 05(16.7%) 07(23.3%) 10(33.3%)
Severity of TBI
(GCS) score
Mild 05(22.7%) 08(36.4%) 02(9.1%) 06(27.3%) 01(4.5%)
0.20Moderate 10(14.1%) 21(29.6%) 11(15.5%) 11(15.5%) 18(25.4%)
Severe 09(11.1%) 17(21.0%) 10(12.3%) 20(24.7%) 25(30.9%)
Pupil reactivity Reactive 18(13.3%) 44(32.6%) 15(11.1%) 29(21.5%) 29(21.5%) 0.007
Non-reactive 06(15.4%) 02(5.1%) 08(20.5%) 08(20.5%) 15(38.5%)
Use of alcohol
before injury
Yes 2(28.6%) 02(28.6%) 0(00.0%) 0(00.0%) 03(42.9%) 0.33
No 22(13.2%) 44(26.3%) 23(13.8%) 37(22.2%) 41(24.6%)
Use of protective
gear, helmet and
seatbelt
Yes 0(00.0%) 01(11.1%) 02(22.2%) 0(00.0%) 06(66.7%)
0.02No 24(14.5%) 45(27.3%) 21(12.7%) 37(22.4%) 38(23.0%)
>90 Minutes 04(6.3%) 27(42.9%) 06(9.5%) 12(19.0%) 14(22.2%)
Complete blood
count
Normal 20(20.8%) 26(27.1%) 11(11.5%) 20(20.8%) 19(19.8%)
0.009Low 01(2.6%) 10(25.6%) 04(10.3%) 06(15.4%) 18(46.2%)
High 03(7.7%) 10(25.6%) 08(20.5%) 11(28.2%) 07(17.9%)
Use of invasive
ventilation during
hospitalization
Yes 13(14.1%) 13(14.1%) 12(13.0%) 21(22.8%) 33(35.9%)
0.000
No 11(13.4%) 33(40.2%) 11(13.4%) 16(19.5%) 11(13.4%)
DISCUSSION
The objective of the study is to determine the
association of falls, motor vehicle accidents and sports
injuries with Traumatic brain injury, to find the
association of age with Traumatic brain injury and to
identify the association of gender and occupation with
Traumatic brain injury. In our study, we found that the
majority of TBI patients 69 (39.7%) had a Road traffic
accident, 49 (28.2%) had a history of falls, 16 (9.2%)
had assault, and 15 (8.6%) had blast injury. Similarly,
in a study conducted in Addis Ababa, the capital of
Ethiopia, the most frequent cause of trauma was road
traffic accidents (RTA), which affected 43 patients
(30.7%), Fall accidents and stick injuries affected 41
patients (29.5%) and 40 patients (286.6%),
respectively. Road traffic accident was the common
cause of traumatic brain injury (TBI). In our study,
RTA was higher due to not use of protective gear,
helmet and seatbelt.15 In our study majority of the
patients, 118 (67.8%) were male, 54 (31%) were
female and 02 (1.1%) were transgender. Age
distribution in our study in which the majority of the
patients 80 (46%) were in the age of 15-29 years.
Similarly, in a study conducted in St Mary’s Hospital,
Lacor, northern Uganda which161 patients (83⋅0%)
were male, and 129 patients (66⋅5%) belonged to the
reproductive age group. In total, 155 patients, or 79%
of the total, were younger than 40 years old. Both the
study show that the majority of male are involved in
traumatic brain injury and their ages were less than 40
years.16 In our study majority of the TBI patients, 46
(26.4%) had extradural hematoma. Similarly, a study
was conducted in Karachi in which 127 TBI patients
participated. There were 116 (91.3%) men and 11
(8.7%) women. Motorcycle accidents were the most
common cause of TBI 78 (61.4%). Contusions were
the most common type of TBI on CT imaging,
Factors Associated with Traumatic Brain Injury in Patients
17 J Gandhara Nurs Alli Health Sci January - June 2025
Table 2: Comparison of different CT scan findings of TBI with other associated factors
Variable Categories Subdural
Hematoma
Extradural
Hematoma
Subarachnoid
Hemorrhage
Cerebral
contusion
Multiple
finding
P-
Value
Age
15-29 11(13.8%) 24(30.0%) 07(8.8%) 19(23.8%) 19(23.8%)
0.69
30-44 08(13.6%) 14(23.7%) 08(13.6%) 11(18.6%) 18(30.5%)
45-59 02( 9.1%) 07(31.8%) 05(22.7%) 04(18.2%) 04(18.2%)
60-74 03(25.0%) 01(08.3%) 03(25.0%) 03(25.0%) 02(16.7%)
>74 0(00.0%) 0(00.0%) 0(00.0%) 0(00.0%) 01(100.0%)
Gender
Male 16(13.6%) 29(24.6%) 19(16.1%) 25(21.2%) 29(24.6%)
0.59Female 07(13.0%) 17(31.5%) 04(07.4%) 12(22.2%) 14(25.9%)
Transgender 01(50.0%) 0(00.0%) 0(00.0%) 0(00.0%) 01(50.0%)
How did the injury
occur
RTA 08(11.6%) 21(30.4%) 07(10.1%) 14(20.3%) 19(27.5%)
0.03
History of fall 07(14.3%) 18(36.7% 07(14.3%) 09(18.4%) 08(16.3%)
Sport injury 03(18.8%) 02(12.5%) 01(6.3%) 03(18.8%) 07(43.8%)
Blast injury due to
explosion 01(50.0%) 0(00.0%) 01(50.0%) 0(00.0%) 0(00.0%)
Assault 04(26.7%) 0(00.0%) 01(6.7%) 05(33.3%) 05(33.3%)
Being stuck by an
object 01(6.7%) 04(26.7%) 04(26.7%) 01(6.7%) 05(33.3%)
Other 0(00.0%) 01(12.5%) 02(25.0%) 05(62.5%) 0(00.0%)
Location of injury
Frontal 06(13.6%) 14(31.8%) 03(6.8%) 13(29.5%) 08(18.2%)
0.13
Temporal 05(18.5%) 10(37.0%) 04(14.8%) 02(7.4%) 06(22.2%)
Parietal 04(17.4%) 07(30.4%) 04(17.4%) 05(21.7%) 03(13.0%)
Occipital 06(17.6%) 07(20.6%) 07(20.6%) 07(20.6%) 07(20.6%)
Multiple locations 03(6.5%) 08(17.4%) 05(10.9%) 10(21.7%) 20(43.5%)
High 03(10.0%) 05(16.7%) 05(16.7%) 07(23.3%) 10(33.3%)
Severity of TBI
(GCS) score
Mild 05(22.7%) 08(36.4%) 02(9.1%) 06(27.3%) 01(4.5%)
0.20Moderate 10(14.1%) 21(29.6%) 11(15.5%) 11(15.5%) 18(25.4%)
Severe 09(11.1%) 17(21.0%) 10(12.3%) 20(24.7%) 25(30.9%)
Pupil reactivity Reactive 18(13.3%) 44(32.6%) 15(11.1%) 29(21.5%) 29(21.5%) 0.007
Non-reactive 06(15.4%) 02(5.1%) 08(20.5%) 08(20.5%) 15(38.5%)
Use of alcohol
before injury
Yes 2(28.6%) 02(28.6%) 0(00.0%) 0(00.0%) 03(42.9%) 0.33
No 22(13.2%) 44(26.3%) 23(13.8%) 37(22.2%) 41(24.6%)
Use of protective
gear, helmet and
seatbelt
Yes 0(00.0%) 01(11.1%) 02(22.2%) 0(00.0%) 06(66.7%)
0.02No 24(14.5%) 45(27.3%) 21(12.7%) 37(22.4%) 38(23.0%)
>90 Minutes 04(6.3%) 27(42.9%) 06(9.5%) 12(19.0%) 14(22.2%)
Complete blood
count
Normal 20(20.8%) 26(27.1%) 11(11.5%) 20(20.8%) 19(19.8%)
0.009Low 01(2.6%) 10(25.6%) 04(10.3%) 06(15.4%) 18(46.2%)
High 03(7.7%) 10(25.6%) 08(20.5%) 11(28.2%) 07(17.9%)
Use of invasive
ventilation during
hospitalization
Yes 13(14.1%) 13(14.1%) 12(13.0%) 21(22.8%) 33(35.9%)
0.000
No 11(13.4%) 33(40.2%) 11(13.4%) 16(19.5%) 11(13.4%)
DISCUSSION
The objective of the study is to determine the
association of falls, motor vehicle accidents and sports
injuries with Traumatic brain injury, to find the
association of age with Traumatic brain injury and to
identify the association of gender and occupation with
Traumatic brain injury. In our study, we found that the
majority of TBI patients 69 (39.7%) had a Road traffic
accident, 49 (28.2%) had a history of falls, 16 (9.2%)
had assault, and 15 (8.6%) had blast injury. Similarly,
in a study conducted in Addis Ababa, the capital of
Ethiopia, the most frequent cause of trauma was road
traffic accidents (RTA), which affected 43 patients
(30.7%), Fall accidents and stick injuries affected 41
patients (29.5%) and 40 patients (286.6%),
respectively. Road traffic accident was the common
cause of traumatic brain injury (TBI). In our study,
RTA was higher due to not use of protective gear,
helmet and seatbelt.15 In our study majority of the
patients, 118 (67.8%) were male, 54 (31%) were
female and 02 (1.1%) were transgender. Age
distribution in our study in which the majority of the
patients 80 (46%) were in the age of 15-29 years.
Similarly, in a study conducted in St Mary’s Hospital,
Lacor, northern Uganda which161 patients (83⋅0%)
were male, and 129 patients (66⋅5%) belonged to the
reproductive age group. In total, 155 patients, or 79%
of the total, were younger than 40 years old. Both the
study show that the majority of male are involved in
traumatic brain injury and their ages were less than 40
years.16 In our study majority of the TBI patients, 46
(26.4%) had extradural hematoma. Similarly, a study
was conducted in Karachi in which 127 TBI patients
participated. There were 116 (91.3%) men and 11
(8.7%) women. Motorcycle accidents were the most
common cause of TBI 78 (61.4%). Contusions were
the most common type of TBI on CT imaging,
Factors Associated with Traumatic Brain Injury in Patients
18J Gandhara Nurs Alli Health Sci
JGNAHS
January - June 2025
accounting for 55 (43.3%), followed by extradural
haemorrhage (EDH) 48 (37.7%), subdural
haemorrhage (SDH) 46 (36.2%), skull fracture 33
(26.0%), subarachnoid haemorrhage (SAH) 30
(23.6%), intracranial (IC) bleed 14 (11.0%),
intraventricular haemorrhage (IVH) 8 (6.3%), and
diffuse axonal injury (DAI) 8 (6.3%). In both the study,
there are no significant differences in extradural
hematoma patients which leads to TBI. In majority of
the extradural hematoma patients, RTA is one of the
common causes which lead to TBI.17 Alcohol use
before injury in which majority of the patients 167
(96%) in our study did not use alcohol while 7 (4%)
had used alcohol before injury. Similarly, a study
conducted in New Zealand in which the procedure for
selecting cases, led to 425 cases being included. All
patient’s baseline characteristics are shown, along with
a comparison between the groups with and without
alcohol involvement. Out of 425 cases, 97 were found.
Alcohol-related incidents were 22.8%, whereas
alcohol-free incidents were 328/425, or 77.2%. Both
studies show that the majority of the participants did
not use alcohol use before injury.18
LIMITATIONS
The study has several limitations. It was conducted at a
single center, limiting the generalizability of the
findings. The use of purposive sampling may introduce
selection bias, while self-reported data on alcohol use,
protective gear, and healthcare timing could be subject
to recall bias. The study focused on a limited number
of variables, excluding broader socioeconomic and
environmental factors. Its cross-sectional design
prevents establishing causality between variables and
outcomes. Despite appropriate sample size calculation,
it may lack power for detecting smaller effects. Lastly,
the absence of follow-up data restricts insights into
long-term recovery patterns.
CONCLUSIONS
The majority of the patients were between the ages of
15-29 years, TBI was more common in males, students
experienced more TBI than other occupation groups,
the majority of the patients had a history of road traffic
accident, CT scan finding of the patients shows that
majority of the patients had extradural Hematoma,
GCS score of the TBI patients was recorded in which
most of the patients had severe traumatic brain injury.
Thus our result indicates in the study that traumatic
brain injury is common in young male students having
road traffic accidents which lead to traumatic brain
injury mainly extradural hematoma.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
REFERENCES
1. Asmamaw Y, Yitayal M, Debie A, Handebo S. The costs of
traumatic head injury and associated factors at University of
Gondar Specialized Referral Hospital , Northwest. BMC Public
Health. 2019;19(October):1–7.
2. Paolo Gritti , Rosalia Zangari , Alessandra Carobbio AZ,
Ferdinando Luca Lorini , Francesco Ferri , Cristina Agostinis
LAL, Carlo Brembilla , Camillo Foresti , Tiziano Barbui FB.
Acute and Subacute Outcome Predictors in Moderate and
Severe Traumatic Brain Injury_ A Retrospective Monocentric
Study - ScienceDirect. World Neurosurg. 2019;128(04):531–
40.
3. Wiles MD, Braganza M, Edwards H, Krause E, Jackson J, Tait
F. Management of traumatic brain injury in the non-
neurosurgical intensive care unit: a narrative review of current
evidence. Vol. 78, Anaesthesia. John Wiley and Sons Inc;
2023. p. 510–20.
4. Islam MS, Rahman MF, Islam MA. Patterns and Outcome of
Traumatic Brain Injury Patients: A Study in a Tertiary Level
Military Hospital. J Armed Forces Med Coll Bangladesh.
2020;15(1):75–8.
5. onow RH, Quistberg A, Rivara FP, Vavilala MS. Intensive
Care Unit Admission Patterns for Mild Traumatic Brain Injury
in the USA. Neurocrit Care. 2019 Feb 15;30(1):157–70.
6. Ponsford J. Factors contributing to outcome following
traumatic brain injury. NeuroRehabilitation. 2013;32(4):803–
15.
7. Jiang JY, Gao GY, Feng JF, Mao Q, Chen LG, Yang XF, et al.
Traumatic brain injury in China. Lancet Neurol [Internet].
2019;18(3):286–95. Available from:
http://dx.doi.org/10.1016/S1474-4422(18)30469-1
8. Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C,
Andelic N, et al. Traumatic brain injury: progress and
challenges in prevention, clinical care, and research. Lancet
Neurol. 2022;21(11):1004–60.
9. Demlie TA, Alemu MT, Messelu MA, Wagnew F, Mekonen
EG. Incidence and predictors of mortality among traumatic
brain injury patients admitted to Amhara region Comprehensive
Specialized Hospitals, northwest Ethiopia, 2022. BMC Emerg
Med. 2023 Dec 1;23(1):2–11.
10. Assele DD, Lendado TA, Awato MA, Workie SB, Faltamo
WF. Incidence and predictors of mortality among patients with
head injury admitted to Hawassa University Comprehensive
Specialized Hospital, Southern Ethiopia: A retrospective
follow-up study. PLoS One [Internet]. 2021;16(8 August):1–15.
Available from:
http://dx.doi.org/10.1371/journal.pone.0254245
11. Steadman-Pare D, Colantonio A, Ratcliff G, Phil D, Chase S,
Director E, et al. Factors Associated with Perceived Quality of
Life Many Years After Traumatic Brain Injury. Vol. 16, J Head
Trauma Rehabil. 2001.
12. Downing M, Hicks A, Braaf S, Myles D, Gabbe B, Cameron P,
et al. Factors facilitating recovery following severe traumatic
brain injury: A qualitative study. Neuropsychol Rehabil.
2021;31(6):889–913.
Factors Associated with Traumatic Brain Injury in Patients
JGNAHS
January - June 2025
accounting for 55 (43.3%), followed by extradural
haemorrhage (EDH) 48 (37.7%), subdural
haemorrhage (SDH) 46 (36.2%), skull fracture 33
(26.0%), subarachnoid haemorrhage (SAH) 30
(23.6%), intracranial (IC) bleed 14 (11.0%),
intraventricular haemorrhage (IVH) 8 (6.3%), and
diffuse axonal injury (DAI) 8 (6.3%). In both the study,
there are no significant differences in extradural
hematoma patients which leads to TBI. In majority of
the extradural hematoma patients, RTA is one of the
common causes which lead to TBI.17 Alcohol use
before injury in which majority of the patients 167
(96%) in our study did not use alcohol while 7 (4%)
had used alcohol before injury. Similarly, a study
conducted in New Zealand in which the procedure for
selecting cases, led to 425 cases being included. All
patient’s baseline characteristics are shown, along with
a comparison between the groups with and without
alcohol involvement. Out of 425 cases, 97 were found.
Alcohol-related incidents were 22.8%, whereas
alcohol-free incidents were 328/425, or 77.2%. Both
studies show that the majority of the participants did
not use alcohol use before injury.18
LIMITATIONS
The study has several limitations. It was conducted at a
single center, limiting the generalizability of the
findings. The use of purposive sampling may introduce
selection bias, while self-reported data on alcohol use,
protective gear, and healthcare timing could be subject
to recall bias. The study focused on a limited number
of variables, excluding broader socioeconomic and
environmental factors. Its cross-sectional design
prevents establishing causality between variables and
outcomes. Despite appropriate sample size calculation,
it may lack power for detecting smaller effects. Lastly,
the absence of follow-up data restricts insights into
long-term recovery patterns.
CONCLUSIONS
The majority of the patients were between the ages of
15-29 years, TBI was more common in males, students
experienced more TBI than other occupation groups,
the majority of the patients had a history of road traffic
accident, CT scan finding of the patients shows that
majority of the patients had extradural Hematoma,
GCS score of the TBI patients was recorded in which
most of the patients had severe traumatic brain injury.
Thus our result indicates in the study that traumatic
brain injury is common in young male students having
road traffic accidents which lead to traumatic brain
injury mainly extradural hematoma.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
REFERENCES
1. Asmamaw Y, Yitayal M, Debie A, Handebo S. The costs of
traumatic head injury and associated factors at University of
Gondar Specialized Referral Hospital , Northwest. BMC Public
Health. 2019;19(October):1–7.
2. Paolo Gritti , Rosalia Zangari , Alessandra Carobbio AZ,
Ferdinando Luca Lorini , Francesco Ferri , Cristina Agostinis
LAL, Carlo Brembilla , Camillo Foresti , Tiziano Barbui FB.
Acute and Subacute Outcome Predictors in Moderate and
Severe Traumatic Brain Injury_ A Retrospective Monocentric
Study - ScienceDirect. World Neurosurg. 2019;128(04):531–
40.
3. Wiles MD, Braganza M, Edwards H, Krause E, Jackson J, Tait
F. Management of traumatic brain injury in the non-
neurosurgical intensive care unit: a narrative review of current
evidence. Vol. 78, Anaesthesia. John Wiley and Sons Inc;
2023. p. 510–20.
4. Islam MS, Rahman MF, Islam MA. Patterns and Outcome of
Traumatic Brain Injury Patients: A Study in a Tertiary Level
Military Hospital. J Armed Forces Med Coll Bangladesh.
2020;15(1):75–8.
5. onow RH, Quistberg A, Rivara FP, Vavilala MS. Intensive
Care Unit Admission Patterns for Mild Traumatic Brain Injury
in the USA. Neurocrit Care. 2019 Feb 15;30(1):157–70.
6. Ponsford J. Factors contributing to outcome following
traumatic brain injury. NeuroRehabilitation. 2013;32(4):803–
15.
7. Jiang JY, Gao GY, Feng JF, Mao Q, Chen LG, Yang XF, et al.
Traumatic brain injury in China. Lancet Neurol [Internet].
2019;18(3):286–95. Available from:
http://dx.doi.org/10.1016/S1474-4422(18)30469-1
8. Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C,
Andelic N, et al. Traumatic brain injury: progress and
challenges in prevention, clinical care, and research. Lancet
Neurol. 2022;21(11):1004–60.
9. Demlie TA, Alemu MT, Messelu MA, Wagnew F, Mekonen
EG. Incidence and predictors of mortality among traumatic
brain injury patients admitted to Amhara region Comprehensive
Specialized Hospitals, northwest Ethiopia, 2022. BMC Emerg
Med. 2023 Dec 1;23(1):2–11.
10. Assele DD, Lendado TA, Awato MA, Workie SB, Faltamo
WF. Incidence and predictors of mortality among patients with
head injury admitted to Hawassa University Comprehensive
Specialized Hospital, Southern Ethiopia: A retrospective
follow-up study. PLoS One [Internet]. 2021;16(8 August):1–15.
Available from:
http://dx.doi.org/10.1371/journal.pone.0254245
11. Steadman-Pare D, Colantonio A, Ratcliff G, Phil D, Chase S,
Director E, et al. Factors Associated with Perceived Quality of
Life Many Years After Traumatic Brain Injury. Vol. 16, J Head
Trauma Rehabil. 2001.
12. Downing M, Hicks A, Braaf S, Myles D, Gabbe B, Cameron P,
et al. Factors facilitating recovery following severe traumatic
brain injury: A qualitative study. Neuropsychol Rehabil.
2021;31(6):889–913.
Factors Associated with Traumatic Brain Injury in Patients
19 J Gandhara Nurs Alli Health Sci
JGNAHS
LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).
COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.
It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.
January - June 2025
13. Gao G, Wu X, Feng J, Hui J, Mao Q, Lecky F, et al. Clinical
characteristics and outcomes in patients with traumatic brain
injury in China: a prospective, multicentre, longitudinal,
observational study. Lancet Neurol [Internet]. 2020;19(8):670–
7. Available from: http://dx.doi.org/10.1016/S1474-
4422(20)30182-4
14. Laeke T, Tirsit A, Debebe F, Girma B, Gere D, Park KB, et al.
Profile of Head Injuries: Prehospital Care, Diagnosis, and
Severity in an Ethiopian Tertiary Hospital. World Neurosurg
[Internet]. 2019;127(3):e186–92. Available from:
https://doi.org/10.1016/j.wneu.2019.03.044
15. Muehlschlegel S, Carandang R, Ouillette C, Hall W, Anderson
F, Goldberg R. Frequency and impact of intensive care unit
complications on moderate-severe traumatic brain injury: Early
results of the outcome prognostication in traumatic brain injury
(OPTIMISM) study. Neurocrit Care. 2013 Jun;18(3):318–31.
16. Okidi R, Ogwang DM, Okello TR, Ezati D, Kyegombe W,
Nyeko D, et al. Factors affecting mortality after traumatic brain
injury in a resource-poor setting. BJS open. 2020;4(2):320–5.
17. Naz A, Rasheed G, Baig MS, Baqi S. Characteristics and
Outcome of Patients with Traumatic Brain Injury in the
Intensive Care Unit of a Public Sector Hospital in Karachi,
Pakistan. J Dow Univ Heal Sci. 2022;15(3):122–9.
18. Rogan A, Patel V, Birdling J, Lockett J, Simmonds H,
McQuade D, et al. Alcohol and acute traumatic brain injury in
the emergency department. EMA - Emerg Med Australas.
2021;33(4):718–27.
CONTRIBUTORS
1. Zabih Ullah - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision
2. Maham Qazi - Supervision; Final Approval
Factors Associated with Traumatic Brain Injury in Patients
JGNAHS
LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).
COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.
It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.
January - June 2025
13. Gao G, Wu X, Feng J, Hui J, Mao Q, Lecky F, et al. Clinical
characteristics and outcomes in patients with traumatic brain
injury in China: a prospective, multicentre, longitudinal,
observational study. Lancet Neurol [Internet]. 2020;19(8):670–
7. Available from: http://dx.doi.org/10.1016/S1474-
4422(20)30182-4
14. Laeke T, Tirsit A, Debebe F, Girma B, Gere D, Park KB, et al.
Profile of Head Injuries: Prehospital Care, Diagnosis, and
Severity in an Ethiopian Tertiary Hospital. World Neurosurg
[Internet]. 2019;127(3):e186–92. Available from:
https://doi.org/10.1016/j.wneu.2019.03.044
15. Muehlschlegel S, Carandang R, Ouillette C, Hall W, Anderson
F, Goldberg R. Frequency and impact of intensive care unit
complications on moderate-severe traumatic brain injury: Early
results of the outcome prognostication in traumatic brain injury
(OPTIMISM) study. Neurocrit Care. 2013 Jun;18(3):318–31.
16. Okidi R, Ogwang DM, Okello TR, Ezati D, Kyegombe W,
Nyeko D, et al. Factors affecting mortality after traumatic brain
injury in a resource-poor setting. BJS open. 2020;4(2):320–5.
17. Naz A, Rasheed G, Baig MS, Baqi S. Characteristics and
Outcome of Patients with Traumatic Brain Injury in the
Intensive Care Unit of a Public Sector Hospital in Karachi,
Pakistan. J Dow Univ Heal Sci. 2022;15(3):122–9.
18. Rogan A, Patel V, Birdling J, Lockett J, Simmonds H,
McQuade D, et al. Alcohol and acute traumatic brain injury in
the emergency department. EMA - Emerg Med Australas.
2021;33(4):718–27.
CONTRIBUTORS
1. Zabih Ullah - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision
2. Maham Qazi - Supervision; Final Approval
Factors Associated with Traumatic Brain Injury in Patients