The subtype matters: unraveling the clinical impact of TBI variants among patients with isolated blunt head injury and skull fractures.

Introduction: Traumatic Brain Injury (TBI) is a major cause of morbidity and mortality worldwide, with isolated blunt TBIs presenting unique clinical challenges. Despite extensive research, limited studies have examined how specific TBI subtypes, subdural hematoma (SDH), subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), diffuse axonal injury (DAI), and contusions-affect critical outcomes such as in-hospital mortality, ICU length of stay (LOS), and ventilation duration. Understanding these associations is essential for improving patient management and resource allocation.

Objective: This study aims to assess the impact of TBI subtype and size on clinical outcomes, including in-hospital mortality, ICU LOS, and ventilation days, in adult patients with isolated blunt TBI and skull fractures.

Methods: A retrospective cohort analysis was conducted using the ACS-TQIP-PUF (2017-2022). Logistic and linear regression models analyzed TBI subtype, size, demographics, comorbidities, and injury characteristics in patients aged ≥ 15 years with isolated blunt TBI and skull fractures. Polytrauma cases were excluded.

Results: Among 64,111 patients, SDH > 8 mm had the highest association with in-hospital mortality (OR 4.89, p <.01). Larger SDH (> 8 mm), contusions (> 2 cm), and SAH correlated with extended ICU LOS, with DAI leading to the longest ICU stays (+ 5.73 days, p <.01) and ventilation days (+ 8.40 days, p <.01).

Conclusion: TBI subtype and size significantly influence patient outcomes. SDH > 8 mm poses the highest mortality risk, while DAI results in prolonged ICU stays and ventilation. These findings highlight the need for targeted management strategies to optimize care for TBI patients.

Levels of evidence: Level III, retrospective/epidemiological.