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1. The main focus of this study was to underscore the importance of exploring the characteristics of traumatic brain injury (TBI) patients, which have not been extensively investigated, to help establish effective clinical procedures and decisions.
2. Three out of every four trauma patients in the emergency unit had mild TBIs, and those who did not survive showed a significant trend of rapid deterioration.
3. It is crucial to consistently conduct a thorough and comprehensive head-to-toe examination for all trauma patients.



Traumatic brain injury (TBI) is a prevalent neurological condition in emergency units. TBI cases are frequently diagnosed with severe conditions. Underdiagnosis is common in mild TBI cases. As a result, physicians have an uncomprehensive understanding of the patients' characteristics in their daily practice. This study aimed to discuss the characteristics of trauma patients who were diagnosed with TBIs in an emergency unit. We conducted a retrospective cohort observational study to examine the adult population of TBI patients from April 2022 to March 2023. This study collected several data points, including demographics, clinical characteristics, surgical procedures, and disposition distribution. All variables were compiled and summarized using descriptive statistics and analyzed by calculating frequencies and percentages. During the period of this study, 483 trauma patients were admitted to the emergency unit. A total of 361 (74.7%) of these cases were identified as TBIs. Most of the traumatic brain injuries occurred in men (75.6%), with the predominant age range being 18–22 years (22.4%). Mild TBI cases (74.5%) were the most prevalent, followed by moderate (20.2%) and severe (5.3%) TBI cases. The average score from the Glasgow Coma Scale assessment was 15. Most patients (80.9%) had no hypotension, while a greater number of patients (98.1%) did not exhibit hypoxia as a comorbidity. The Injury Severity Score revealed that the highest percentage of TBIs was categorized as minor (62.3%). It was found that 53.5% of the patients were discharged, while 36% of the patients were hospitalized. However, 7 patients (1.9%) passed in the emergency unit, and 30 patients (8.3%) opted to be discharged against medical advice. Only 21 patients (5.8%) received neurosurgical management. As the most prevalent trauma, TBI necessitates careful management to handle the implications of clinical decision-making. It is crucial to investigate the underlying risk of mortality in TBI cases because the majority of patients do not require neurosurgical intervention.


Emergency unit health system patient characteristics traumatic brain injury

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How to Cite
Ramdinal Aviesena Zairinal, Chandrika Najwa Malufti, Yetty Ramli, Diatri Nari Lastri, Adre Mayza, & Pukovisa Prawiroharjo. (2023). Traumatic Brain Injury Patients in the Emergency Unit of a Tertiary Hospital. Folia Medica Indonesiana, 59(3), 289–294.


  1. Aninditha T, Wirataman W (2017). Buku Ajar Neurologi. Buku 2, 2nd edn. Dep. Neurologi. FK UI, Jakarta.
  2. Ankita S, Kunkulol RR, Shaikh M, et al (2015). Hypoxic status and its prognosis in patients with head injury. International Journal of Medical Research & Health Sciences 4, 662. doi: 10.5958/2319-5886.2015.00126.5.
  3. Brazinova A, Rehorcikova V, Taylor MS, et al. (2021). Epidemiology of traumatic brain injury in Europe: A living systematic review. Journal of Neurotrauma 38, 1411–1440. doi: 10.1089/neu.2015.4126.
  4. Carney N, Totten AM, O'Reilly C, et al. (2017). Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80, 6–15. doi: 10.1227/NEU.0000000000001432.
  5. Colnaric JM, El Sibai RH, Bachir RH, et al (2022). Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study. Medicine (Baltimore) 101, e29614. doi: 10.1097/MD.0000000000029614.
  6. Dehouche N (2022). The injury severity score: an operations perspective. BMC Medical Research Methodology 22, 48. doi: 10.1186/s12874-022-01528-6.
  7. Dewan MC, Rattani A, Gupta S, et al (2019). Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery 130, 1080–1097. doi: 10.3171/2017.10.JNS17352.
  8. Eom KS, Kim JH, Yoon SH, et al (2021). Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study. Chinese Journal of Traumatology 24, 333–343. doi: 10.1016/j.cjtee.2021.06.004.
  9. Gaitanidis A, Breen KA, Maurer LR, et al (2021). Systolic blood pressure <110 mm Hg as a threshold of hypotension in patients with isolated traumatic brain injuries. Journal of Neurotrauma 38, 879–885. doi: 10.1089/neu.2020.7358.
  10. Gao G, Wu X, Feng J, et al (2020). Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study. The Lancet Neurology 19, 670–677. doi: 10.1016/S1474-4422(20)30182-4.
  11. Ghandour HZ, Abou-Abbass H, Al-Hajj S, et al (2022). Traumatic brain injury patient characteristics and outcomes in Lebanon: a multicenter retrospective cohort study. Journal of Global Health Reports. doi: 10.29392/001c.32364.
  12. Girshausen R, Horst K, Herren C, et al (2022). Polytrauma scoring revisited: prognostic validity and usability in daily clinical practice. European Journal of Trauma and Emergency Surgery. doi: 10.1007/s00068-022-02035-5.
  13. Hagos A, Tedla F, Tadele A, et al (2022). Pattern and outcome of traumatic brain injury, Addis Ababa, Ethiopia: A cross-sectional hospital-based study. Ethiopian Journal of Health Sciences 32, 343–350. doi: 10.4314/ejhs.v32i2.15.
  14. Howe EI, Andelic N, Fure SCR, et al (2022). Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Services Research 22, 185. doi: 10.1186/s12913-022-07585-3.
  15. Hsia RY, Markowitz AJ, Lin F, et al (2018). Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions. BMJ Open 8, e022297. doi: 10.1136/bmjopen-2018-022297.
  16. Lee YS, Lee HY, Leigh J-H, et al (2021). The socioeconomic burden of acquired brain injury among the Korean patients over 20 years of age in 2015–2017: A prevalence-based approach. Brain & Neurorehabilitation. doi: 10.12786/bn. 2021.14.e24.
  17. Luggya TS, Ngabirano AA, Sarah R, et al (2022). Trauma unit admissions at the Ugandan National Referral Hospital: a descriptive study. African Health Sciences 22, 404–409. doi: 10.4314/ahs. v22i1.49.
  18. Maas AIR, Menon DK, Adelson PD, et al (2017). Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology 16, 987–1048. doi: 10.1016/S1474-4422(17)30371-X.
  19. Maas AIR, Menon DK, Manley GT, et al. (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. The Lancet Neurology 21, 1004–1060. doi: 10.1016/S1474-4422(22)00309-X.
  20. Magalhí£esS ALG, Barros JLVM de, Cardoso MG de F, et al (2022). Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature. Arquivos de Neuro-Psiquiatria 80, 410–423. doi: 10.1590/0004-282 x-anp-2021-0035.
  21. Peeters W, van den Brande R, Polinder S, et al (2015). Epidemiology of traumatic brain injury in Europe. Acta Neurochirurgica (Wien) 157, 1683–1696. doi: 10.1007/s00701-015-2512-7.
  22. Picetti E, Catena F, Abu-Zidan F, et al (2023). Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES). World Journal of Emergency Surgery 18, 5. doi: 10.1186/s13 017-022-00468-2.
  23. Pozzato I, Meares S, Kifley A, et al (2020). Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study. BMJ Open 10, e034494. doi: 10.1136/bmjopen-2019-034494.
  24. Putra KK, Wardani PAIS, Niryana IW (2021). Incidence report of traumatic brain injury in Mimika Public Hospital Papua. Intisari Sains Medis 12, 724–727. doi: 10.15562/ism.v12i3.853.
  25. Rauch S, Marzolo M, Cappello TD, et al (2021). Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas – an analysis of the prospective international Alpine Trauma Registry. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 29, 61. doi: 10.1186/s13049-021-00879-1.
  26. Skaansar O, Tverdal C, Rí¸nning PA, et al (2020). Traumatic brain injury”the effects of patient age on treatment intensity and mortality. BMC Neurology 20, 376. doi: 10.1186/s12883-020-01943-6.
  27. Spaite DW, Hu C, Bobrow BJ, et al (2017). The Effect of Combined Out-of-Hospital Hypo-tension and Hypoxia on Mortality in Major Traumatic Brain Injury. Annals of Emergency Medicine 69, 62–72. doi: 10.1016/j.annemergmed.2016.08.007.
  28. Steyerberg EW, Wiegers E, Sewalt C, et al (2019). Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. The Lancet Neurology 18, 923–934. doi: 10.1016/S1474-4422(19)30232-7.
  29. Valle D, Villarreal XP, Lunny C, et al (2022). Surgical management of neurotrauma: When to intervene. Journal of Clinical Trials and Regulations 4, 41–55. Available at:
  30. Watanitanon A, Lyons VH, Lele A V., et al (2018). Clinical epidemiology of adults with moderate traumatic brain injury. Critical Care Medicine 46, 781–787. doi: 10.1097/CCM.0000000000002991.
  31. Zairinal R (2022). Cedera otak traumatik: Manajemen gawat darurat. Buku ajar neurologi, 2nd edn. Departemen Neurologi Fakultas kedokteran Universitas Indonesia Rumah Sakit Cipto Mangunkusumo, Jakarta.
  32. Zia N, Mehmood A, Namaganda RH, et al (2019). Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry. Trauma Surgery & Acute Care Open 4, e000259. doi: 10.1136/tsaco-2018-000259.