Long-Term Mortality and Quality of Life Among Adults With Mild Traumatic Brain Injury

Importance: Mild traumatic brain injuries (mTBIs) are the most common form of TBI and are responsible for 1.37 million years lived with disability annually, disproportionately affecting low- and middle-income countries (LMICs), as 90% of TBIs occur in LMICs. Objective: To measure the long-term mortality (12 months), quality of life (QoL), and functional status of patients with mTBI in Pakistan. Design, Setting, and Participants: This cohort study was an analysis of prospectively collected data of patients with mTBI from a trauma registry of all injured patients from 2 tertiary care centers in Karachi, Pakistan, from December 2021 to May 2024, who were followed up for 12 months. Participants were adult patients (aged >18 years) admitted with mTBI and enrolled in the registry with recorded outcomes at 1, 3, 6, and 12 months. Exposure: Mild TBI (Glasgow Coma Scale [GCS] score of 13-15). Main Outcomes and Measures: Long-term mortality (12-month cumulative and follow-up) was the primary outcome, and QoL was the secondary outcome. Results: A total of 602 patients presented with mTBI. Most were aged 18 to 39 years (336 patients [55.8%]), were male (502 patients [83.4%]), and experienced mTBIs from road traffic collisions (427 patients [71.1%]), or falls (130 patients [21.6%]). Surgical interventions were performed in 176 cases (29.2%) and were associated with 51% lower odds of 1-month cumulative mortality (adjusted hazard ratio, 0.44; 95% CI, 0.21-0.87). The inpatient, cumulative 1-month, and 12-month mortality rates were 4.6%, 8.9%, and 13.6%, respectively. Patients with a GCS score of 13 (20.2%) and 14 (20.1%) had a higher 12-month mortality rate as compared with patients with a GCS score of 15 (8.3%). Of 345 patients with follow-up data at 1 year, 269 (78.0%) achieved complete independence by 1 year. The functional engagement domain showed the highest rate of recovery (318 patients [92.2%]), while the physical well-being and recovery domain had the lowest, with 286 (82.9%) experiencing disability, particularly those with a GCS score of 13 and 14; only 59 (17.1%) reported no physical disability at 12 months. Conclusion and relevance: In this cohort study of patients with mTBI in Pakistan, 12-month mortality was approximately 2-fold higher in patients with a GCS score of 13 to 14 (20.2% and 20.1%) compared with a GCS score of 15 (8.3%), alongside persistently poorer quality of life in lower-GCS score groups throughout the recovery period.