• Mary J De Silva, Ian Roberts, Pablo Perel, Phil Edwards, Michael G Kenward, Janice Fernandes, Haleema Shakur, Vikram Patel, and CRASH Trial Collaborators.
• Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK. mary.desilva@lshtm.ac.uk
• Int J Epidemiol. 2009 Apr 1; 38 (2): 452-8.

BackgroundTraumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. The burden of TBI is greatest in low- and middle-income countries (LAMIC), yet little is known about patient outcomes in these settings.MethodsComplete data on 8927 patients from 46 countries from the corticosteroid randomization after significant head injury (CRASH) trial were analysed to explore whether outcomes 6 months after TBI differed between high-income countries and LAMIC.ResultsJust under half of patients experienced a good recovery, one-third moderate or severe disability and one-quarter died within 6 months of their injury. Univariate analyses showed that patients in LAMIC were more likely to die following severe TBI, but were less likely to be disabled following mild and moderate TBI. These results were confirmed in multivariate analyses. Compared to patients in high-income countries, patients in LAMIC have over twice the odds of dying following severe TBI (OR 2.23, 95% CI 1.51-3.30) but half the odds of disability following mild (OR 0.41, 95% CI 0.23-0.72) and moderate TBI (OR 0.53, 95% CI 0.35-0.81). There were no differences between settings in the odds of death following either mild or moderate TBI.ConclusionsReduced death rates following severe TBI in patients from high-income countries may be due to differences in medical care which may result in a higher proportion of patients surviving with a disability. Socio-cultural factors may explain the lower levels of disability after mild and moderate TBI in LAMIC.

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