Age and Type of Hemorrhage as Factors Associated with Mortality in Patients with Traffic Accident-Related Head Injuries
DOI:
https://doi.org/10.26911/theijmed.2026.11.3.966Abstract
Background: Road traffic accidents remain a significant global health problem and are among the leading causes of trauma-related mortality, particularly in developing countries. Head injury is one of the most serious consequences of road traffic accidents and contributes substantially to death and disability. Several factors, including age, sex, and type of intracranial haemorrhage, have been reported to affect mortality among patients with head injuries; however, studies in Indonesia have generally examined these factors separately. Evidence regarding the simultaneous relationship of these variables with mortality remains limited. Therefore, this study aimed to analyze the relationship between age, sex, and type of haemorrhage and mortality in patients with head injuries following road traffic accidents.
Subjects and Method: This cross-sectional study included 1,355 patients with head injuries due to road traffic accidents treated at Rumah Sakit Umum Daerah dr. Moewardi, Surakarta. Data on mortality, age, sex, and type of hemorrhage were collected from medical records (January 2023–January 2026) and analyzed using multiple logistic regression.
Results: Older adults had a significantly higher risk of mortality than adults (OR= 2.03; 95% CI= 1.66 to 2.47; p<0.05). No significant association was found between sex and mortality (p>0.05). Mortality was significantly associated with the type of hemorrhage (p<0.05), with subdural hemorrhage showing the highest mortality rate (26.5%). Multivariate analysis demonstrated that age (aOR= 2.34; 95% CI= 1.77 to 3.08; p<0.05) and type of hemorrhage (aOR= 1.44; 95% CI= 1.22 to 1.71; p<0.05) were independent predictors of mortality, with age contributing more strongly to the model.
Conclusion: Advanced age and subdural haemorrhage significantly associated with increased mortality in patients with head injuries following road traffic accidents, whilst gender was not found to be a significant factor.
References
Astuti RK, Veibiani NA (2025). Factors influencing events dysfunction cogni-tive post operation on patient elderly: systematic review. Indones J Med. 10(3): 237–248. doi:10.26911/-theijmed.2025.10.3.871.
Baker CE, Martin P, Wilson MH, Ghajari M, Sharp DJ (2022). The relationship between road traffic collision dynamics and traumatic brain injury pathology. Brain Commun. 4(2): fcac033. doi:10.1093/braincomms/fcac033.
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. (2017). Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 80(1): 6–15. doi:10.1227/NEU.0000000000001432.
Dunne J, Quiñones-Ossa GA, Still EG, Suarez MN, González-Soto JA, Vera DS, et al. (2020). The epidemiology of traumatic brain injury due to traffic accidents in Latin America: a narrative review. J Neurosci Rural Pract. 11(2): 287–290. doi:10.1055/s-0040-1709363.
Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT (2018). Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 35(7): 889–906. doi:10.1089/neu.2017.5371.
Griswold DP, Fernandez L, Rubiano AM (2022). Traumatic subarachnoid hemorrhage: a scoping review. J Neurotrauma. 39(1–2): 35–48. doi:10.1089/neu.2021.0007.
Igbokwe KK, Ayogu OM, Onobun DE, Essiet EA, Ugwuanyi UC (2021). The outcomes of traumatic acute subdural hematoma in a tertiary center in Abuja, Nigeria. Cureus. 13(11): e20016. doi:10.7759/cureus.20016.
Jochems D, van Rein E, Niemeijer M, van Heijl M, van Es MA, Nijboer T, et al. (2021). Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands. Sci Rep. 11: 19985. doi:10.1038/s41598-021-99484-6.
Khairat A, Margetis K, Waseem M (2026). Epidural hematoma. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Krueger EM, Putty M, Young M, Gaynor B, Omi E, Farhat H (2019). Neurosurgical outcomes of isolated hemorrhagic mild traumatic brain injury. Cureus. 11(10): e5982. doi:10.7759/cureus.5982.
Mattingly E, Roth CR (2022). Traumatic brain injury in older adults: epide-miology, etiology, rehabilitation, and outcomes. Perspect ASHA Spec Interest Groups. 7(4): 1166–1181. doi:10.1044/2022_PERSP-21-00129.
Mudzakir MT, Susanti R, Noverial (2020). Karakteristik kasus kematian dengan temuan cedera kepala periode 2018–2019 (Characteristics of Fatal Cases with Head Injury Findings, 2018–2019). Jurnal Ilmu Kesehatan Indonesia. 1(2). doi:10.25077/jikesi.v1i2.148.
Nugroho AW, Masrika NUE (2025). The epidemiology of motorcycle-related acute traumatic brain injury: the NOMADEN study. Surg Neurol Int. 16: 27. doi:10.25259/SNI_929_2024.
Paget L-M, Boutonnet M, Moyer J-D, Delhaye N, D'Aranda E, Beltzer N, et al. (2021). Trauma centre admissions for traumatic brain injury in France: one-year epidemiological analysis of prospectively collected data. Anaesth Crit Care Pain Med. 40(1): 100804. doi:10.1016/j.accpm.2021.100804.
Pruitt P (2022). Subdural hematoma. In: Naidech AM, editor. Neurocritical Care. Cambridge: Cambridge Univer-sity Press. doi:10.1017/9781108907682.010.
Puspoprodjo WU, Laila NN (2021). Studi pemahaman dan perilaku keselamatan berkendara (safety riding) pada remaja dan usia produktif di Pulau Jawa (A Study of Understanding and Safe Riding Behaviors Among Adolescents and Working-Age Adults in Java Island). Jurnal Ilmiah Kesehatan. 20(3): 118–126. doi: 10.33221/jikes.v20i3.1480.
Rahman U, Hamid M, Shan Dasti M, Nouman T, Vedovelli L, Javid A (2022). Traumatic brain injuries: a cross-sectional study of traumatic brain injuries at a tertiary care trauma center in the Punjab, Pakistan. Disaster Med Public Health Prep. 17: e89. doi:10.1017/dmp.2021.361.
Rau CS, Wu SC, Hsu SY, Liu HT, Huang CY, Hsieh TM, et al. (2019). Concurrent types of intracranial hemorrhage are associated with a higher mortality rate in adult patients with traumatic subarachnoid hemorrhage: a cross-sectional retro-spective study. Int J Environ Res Public Health. 16(23): 4787. doi:10.3390/ijerph16234787.
Rosen HE, Khalaf MK, Mitra S, Neki K, Hyder AA, Paichadze N (2025). Factors associated with mortality of hospitalized road traffic injury patients in 4 low- and middle-income countries. Traffic Inj Prev. 26(8): 1027–1032. doi:10.1080/15389588.2025.-2471558.
Rusman AA, Fiddiyanti I, Pratama Y. (2025). Description of Injury Patterns in Traffic Accident Victims of Motorcyclist in the Emergency Room TK. II 03.05.01 Dustira Hospital Cimahi Year 2021-2022. Jurnal Eduhealth. 16(4). 10.54209/eduhealth.v16i04.
Shpiner AC, Bugaev N, Riesenburger R, Ng I, Breeze JL, Arabian SS, et al. (2019). The profile of blunt traumatic supratentorial cranial bleed types. J Clin Neurosci. 59: 79–83. doi:10.-1016/j.jocn.2018.10.149.
Tanan N, Sjafruddin A, Idris M (2025). The characteristics of road crashes on Indonesian national roads based on integrated road safety management system data. Period Polytech Transp Eng. 53(1): 67–76. doi:10.3311/PPtr.-36654.
Wu E, Marthi S, Asaad WF (2020). Pre-dictors of mortality in traumatic intracranial hemorrhage: a National Trauma Data Bank study. Front Neurol. 11: 587587. doi:10.3389/-fneur.2020.587587.
Yu Z, Xing J, Wang B, Hang H, Ye S (2025). Development of a predictive model for prolonged length of stay in conservatively treated patients with spontaneous intracerebral hemo-rrhage: a retrospective study. J Clin Neurosci. 136: 111222. doi:10.1016/-j.jocn.2025.111222.
