Outcomes and quality of life in severe traumatic brain injury: A retrospective Single-Center Study of 57 Cases at Hassan II University Hospital, Fez, Morocco

Background: Severe traumatic brain injury (sTBI) is a leading cause of death and long-term disability worldwide, disproportionately affecting young adults in low- and middle-income countries (LMICs). Data on neurological outcomes and quality of life after sTBI from North Africa remain scarce. We describe the epidemiological profile, management modalities, in-hospital outcomes, and functional recovery up to 6 months in patients with sTBI admitted to the ICU of Hassan II University Hospital, Fez, Morocco.
Methods: A retrospective descriptive and analytical single-center study was conducted in the Polyvalent ICU Unit A1 of Hassan II University Hospital, Fez, Morocco, from March 2018 to May 2021. Patients aged ≥16 years admitted for isolated or polytraumatic sTBI (Glasgow Coma Scale [GCS] ≤8 and/or potentially evolving intracranial lesions) were included. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at ICU discharge, 3 months, and 6 months. Univariate analysis of prognostic factors was performed using Student's t-test and Chi-square test (significance threshold: p<0.05) with SPSS version 21.
Results: Fifty-seven patients were enrolled. Mean age was 32.8 years (range 16–68); 94% were male (sex ratio 18:1). Road traffic accidents (RTAs) accounted for 64.9% of injuries. Mean admission GCS was 7.9 (range 3–14). Cerebral contusions (61.4%) and acute subdural hematomas (56.1%) were the predominant CT findings. Twenty-two patients (38.6%) underwent emergency neurosurgical intervention. In-hospital mortality was 49.1% (n=28), primarily attributable to refractory intracranial hypertension (IH, 57%). Among survivors followed at 6 months (n=23), 65.2% achieved a good functional recovery (GOS 5). Statistically significant prognostic factors for death were: low admission GCS (p=0.028), hemodynamic instability (p=0.035), intracranial hypertension (p=0.001), subarachnoid hemorrhage (SAH, p=0.022), and nosocomial infection (p=0.031).
Conclusion: sTBI carries a 49.1% in-hospital mortality rate in this Moroccan ICU cohort, yet survivors demonstrate remarkable progressive neurological recovery, with 65.2% achieving good functional outcome at 6 months. Key therapeutic targets include aggressive prevention and management of secondary brain insults, intracranial hypertension, and nosocomial infections. Strengthening prehospital care systems and road safety policies represents the highest-priority preventive intervention in this context.