TITLE:
Secondary Systemic Insults (ACSOS) in Severe Traumatic Brain Injury (TBI)
AUTHORS:
Mangané Moustapha, Diop Thierno Madane, Almeimoune Abdoul Hamidou, Aladji Seidou Dembelé, Youssouf Sogoba, Tagne Nghotue Franklin, Diallo Daouda, Kassogué André, Tatfo Gaius, Sanogo Dramane, Soumaré Alfousseine, Gamby Amadou, Koita Siriman, Coulibaly Mahamadoun, Harouna Sangare, Diango Djibo Mahamane
KEYWORDS:
Prognostic Factors, ACSOS, Severe TBI, Emergency Department, Gabriel-Touré University Hospital
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.14 No.1,
January
14,
2026
ABSTRACT: 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 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 were highly lethal (RR ≈ 1.7; p Conclusion: Early identification and correction of secondary systemic insults are crucial to improving the prognosis of severe TBI.