Assessment of Hospital Mortality and Predictors of Traumatic Acute Subdural Hematoma in Addis Ababa, Ethiopia, 2025.

Abstract

Abstract Background: Traumatic Acute Subdural Hematoma (TASDH) is among the most lethal forms of traumatic brain injury, with a high global mortality rate. In low- and middle-income countries like Ethiopia, the burden of TASDH is significant, yet local data on mortality and its predictors remain scarce. This study aimed to determine the in-hospital mortality rate and identify key predictors of death among TASDH patients in Addis Ababa. Methods: A hospital based cross sectional study was conducted on 272 patients with TASDH admitted to Addis Ababa Burn, Emergency and Trauma (AaBET) Hospital and the All-Africa Leprosy Rehabilitation and Training Center (ALERT) from January 2023 to September 2025. Data on sociodemographic, clinical presentation, radiological findings, and treatment outcomes were extracted from medical records. A binary logistic regression model was used to identify independent predictors of in-hospital mortality. Results: The in-hospital mortality rate was 22.79%. Multivariate analysis revealed that a lower Glasgow Coma Scale (GCS) score at admission was the principal predictor of mortality. Compared to patients with a GCS of 3-8, those with a GCS of 9-13 had 90% lower odds of death (AOR=0.10, 95% CI: 0.016–0.70), and those with a GCS of 14-15 had 99% lower odds (AOR=0.011, 95% CI: 0.007–0.172). The presence of bilateral non-reactive pupils significantly increased the odds of mortality (AOR=20.64, 95% CI: 2.23–190.87). Radiologically, a hematoma thickness greater than 10 mm was a strong independent predictor of death (AOR=7.51, 95% CI: 1.80–31.29). Conclusion: The mortality rate from TASDH in this setting is high. The initial GCS, pupillary reactivity, and hematoma thickness are strong independent predictors of in-hospital mortality. These findings emphasize the critical need for rapid neurological assessment, timely neuroimaging and urgent intervention to improve outcomes for patients with TASDH. Keywords: Traumatic Brain Injury, Acute Subdural Hematoma, In-Hospital Mortality, Prognostic Factors, Ethiopia.