Secondary Systemic Insults (ACSOS) in Severe Traumatic Brain Injury (TBI)

Introduction: Severe Traumatic Brain Injury (TBI) remains both frequent and serious in low-resource settings. Secondary Systemic Brain Injuries (SSBI) are physiological disorders (cardiovascular, respiratory, metabolic) occurring after an initial brain injury that aggravate the initial lesions and are life-threatening. They include hypotension, hypoxia, hypo/hypercapnia, anaemia, hypo/hyperglycaemia, hypo/hyperthermia, and cerebral oedema, causing further ischaemia and cellular damage. Objective: The objective of this study was to evaluate the impact of secondary systemic insults (ACSOS) on the prognosis of severe TBI in the Emergency Department. Methodology: This was a descriptive and analytical cross-sectional study conducted in the Emergency Department of Gabriel-Touré University Hospital (Bamako) from 1 February 2024 to 28 February 2025. It included all patients with severe TBI (Glasgow Coma Scale ≤ 8). Data entry and analysis were performed using SPSS 22.0, with graphs generated in Excel. Qualitative variables were compared using the Chi-square or Fisher’s exact test depending on sample size, with a significance level set at p < 0.05. Informed consent was obtained. Results: During the study period, 19,991 patients were admitted to the Emergency Department, including 1500 cases of TBI (7.5%), of which 430 were severe (28.6%). The population was predominantly young (mean age 27 ± 17 years) and male (76%). Road traffic accidents accounted for 64.7% of cases, with 90% of patients transported by firefighters. Clinical and biological findings included loss of consciousness (89%), hypoxia (19%), anaemia (23.3%), and hypernatraemia (9.8%). Brain CT was performed in all cases, and transcranial Doppler (TCD) in 48% of severe TBI cases. Management included neurosedation (100%), mechanical ventilation (100%), osmotherapy (45%), and surgery in 21% of cases—mainly decompressive craniectomy (10%) and haematoma evacuation (5%). Complications occurred in 45% of admissions, primarily ventilator-associated pneumonia (25%), sepsis (15%), and urinary tract infections (5%). The mortality rate was 60.7%, with a mean hospital stay of 10 ± 5 days. Female sex (RR 1.22; p = 0.027), age over 40 years (p = 0.001), and certain secondary systemic insults—particularly hypoxia, anaemia, hyperglycaemia, and hypernatraemia (RR 1.22 - 1.41; p ≤ 0.031)—were associated with increased mortality. Among complications, ventilator-associated pneumonia and urinary tract infections