Severity of Head Injury and Duration of Hospital Stay: A Comparative Analysis of Length of Stay Across Mild, Moderate, And Severe Traumatic Brain Injury
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Abstract
Head injury is a leading cause of hospital admission and prolonged inpatient care, imposing a substantial burden on emergency and critical-care resources, particularly in low- and middle-income settings. Although the severity of the initial injury is widely assumed to drive resource use, locally quantified evidence linking injury severity to length of stay (LOS) remains limited. This analytical cross-sectional study therefore examined whether the mean length of hospital stay differs among patients with mild, moderate, and severe head injury. Records of 152 head-injury patients presenting to the emergency department were reviewed; head-injury severity was classified from the admission Glasgow Coma Scale, and LOS was recorded in days. Data were analysed in IBM SPSS Statistics, with normality assessed using the Shapiro–Wilk test and homogeneity of variance using Levene's test; group means were compared using one-way ANOVA, supported by the Welch robust test given unequal variances, with Games–Howell and Tukey HSD post-hoc procedures, and effect size quantified using eta-squared (η²) and omega-squared (ω²). Mean LOS increased monotonically with severity, from 3.39 ± 1.14 days in the mild group (n = 60) to 7.34 ± 2.30 days in the moderate group (n = 52) and 14.25 ± 3.49 days in the severe group (n = 40). Residuals within each group were normally distributed (Shapiro–Wilk p > 0.05), whereas variances were heterogeneous (Levene p < 0.001). Both the one-way ANOVA, F(2, 149) = 257.19, p < 0.001, and the Welch robust test, F(2, 71.37) = 221.45, p < 0.001, were highly significant, and the effect was very large (η² = 0.775; ω² = 0.771), indicating that injury severity accounted for approximately 77% of the variance in LOS; all three pairwise comparisons were significant (Games–Howell, all p < 0.001). Length of hospital stay thus differs significantly across head-injury severity grades and rises sharply from mild to severe injury. Admission severity is a strong, clinically meaningful predictor of inpatient duration and can inform early bed planning, resource allocation, and family counselling in emergency settings.
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References
I. Ahmadi, S., Sarveazad, A., Babahajian, A., Ahmadzadeh, K., & Yousefifard, M. (2023). Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score for prediction of in-hospital mortality in traumatic brain injury patients: A systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery, 49(4), 1693–1706. https://doi.org/10.1007/s00068-022-02111-w
II. Åkerlund, C. A. I., Holst, A., Stocchetti, N., Steyerberg, E. W., Menon, D. K., Ercole, A., Nelson, D. W., Åkerlund, C., Amrein, K., Andelic, N., Andreassen, L., Anke, A., Antoni, A., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Barzó, P., Beauvais, R., … the CENTER-TBI Participants and Investigators. (2022). Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: A CENTER-TBI study. Critical Care, 26(1), 228. https://doi.org/10.1186/s13054-022-04079-w
III. Bögli, S. Y., Beqiri, E., Olakorede, I., Cherchi, M. S., Smith, C. A., Chen, X., Di Tommaso, G., Rochat, T., Tanaka Gutiez, M., Cucciolini, G., Motroni, V., Helmy, A., Hutchinson, P., Lavinio, A., Newcombe, V. F. J., & Smielewski, P. (2025). Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: Lessons and insights from cases, events, and patterns. Critical Care, 29(1), 139. https://doi.org/10.1186/s13054-025-05360-4
IV. Clark, D., Joannides, A., Adeleye, A. O., Bajamal, A. H., Bashford, T., Biluts, H., Budohoski, K., Ercole, A., Fernández-Méndez, R., Figaji, A., Gupta, D. K., Härtl, R., Iaccarino, C., Khan, T., Laeke, T., Rubiano, A., Shabani, H. K., Sichizya, K., Tewari, M., … Ziga, M. (2022). Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: A prospective observational cohort study. The Lancet Neurology, 21(5), 438–449. https://doi.org/10.1016/S1474-4422(22)00037-0
V. Haarbauer-Krupa, J., Pugh, M. J., Prager, E. M., Harmon, N., Wolfe, J., & Yaffe, K. (2021). Epidemiology of Chronic Effects of Traumatic Brain Injury. Journal of Neurotrauma, 38(23), 3235–3247. https://doi.org/10.1089/neu.2021.0062
VI. Jiang, D., Chen, T., Yuan, X., Shen, Y., & Huang, Z. (2023). Predictive value of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) and Revised Trauma Score (RTS) for the short-term mortality of patients with isolated traumatic brain injury. The American Journal of Emergency Medicine, 71, 175–181. https://doi.org/10.1016/j.ajem.2023.06.030
VII. Krishnamoorthy, V., & Vavilala, M. S. (2022). Traumatic Brain Injury and Chronic Implications Beyond the Brain. JAMA Network Open, 5(4), e229486. https://doi.org/10.1001/jamanetworkopen.2022.9486
VIII. Lee, S.-J., Chen, Y.-L., Wu, T.-H., Liu, C.-Y., Wang, C.-H., Tsai, C.-H., Chung, J.-Y., Yiang, G.-T., & Wu, M.-Y. (2025). Comparison of Glasgow coma scale, motor component, eye component, and simplified motor scale for predicting trauma outcomes: A 13-year multicenter retrospective cohort study. BMC Emergency Medicine, 25(1), 86. https://doi.org/10.1186/s12873-025-01246-4
IX. Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Büki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., … Zemek, R. (2022). Traumatic brain injury: Progress and challenges in prevention, clinical care, and research. The Lancet Neurology, 21(11), 1004–1060. https://doi.org/10.1016/S1474-4422(22)00309-X
X. Maldonado-McGrath, D., Sacknovitz, A., Aifuwa, E., Kronen, S., Jain, A., Calixte, A., Elmashad, A., & Al-Mufti, F. (2025). Monitoring Cortical Spreading Depolarization: Advancements and Applications in Neurocritical Care: A Scoping Review. Synapse, 79(4), e70021. https://doi.org/10.1002/syn.70021
XI. Meyfroidt, G., Bouzat, P., Casaer, M. P., Chesnut, R., Hamada, S. R., Helbok, R., Hutchinson, P., Maas, A. I. R., Manley, G., Menon, D. K., Newcombe, V. F. J., Oddo, M., Robba, C., Shutter, L., Smith, M., Steyerberg, E. W., Stocchetti, N., Taccone, F. S., Wilson, L., … Citerio, G. (2022). Management of moderate to severe traumatic brain injury: An update for the intensivist. Intensive Care Medicine, 48(6), 649–666. https://doi.org/10.1007/s00134-022-06702-4
XII. Rakhit, S., Nordness, M. F., Lombardo, S. R., Cook, M., Smith, L., & Patel, M. B. (2021). Management and Challenges of Severe Traumatic Brain Injury. Seminars in Respiratory and Critical Care Medicine, 42(1), 127–144. https://doi.org/10.1055/s-0040-1716493
XIII. Santoso, E. B., Wahyono, A., Waladani, B., & Suwaryo, P. A. W. (2026). Pengaruh Moda Transportasi Pre-Hospital terhadap Risiko Perburukan Cedera Kepala. Journal of Health Science, 3(1), 8–17.
https://doi.org/10.63425/ljhs.v3i1.154
XIV. Suwaryo, P. A. W., Kadir, F., Omar, A., Darsin Singh, S. K., & Bolong, M. F. (2024). The impact of interpersonal support on quality of life in traumatic brain injury patients – a one-month post-treatment analysis. European Journal of Clinical and Experimental Medicine, (3), 538–542. https://doi.org/10.15584/ejcem.2024.3.8
XV. Swanson, T. M., Isaacson, B. M., Cyborski, C. M., French, L. M., Tsao, J. W., & Pasquina, P. F. (2017). Traumatic Brain Injury Incidence, Clinical Overview, and Policies in the US Military Health System Since 2000. Public Health Reports®, 132(2), 251–259. https://doi.org/10.1177/0033354916687748
XVI. Waladani, B., Suwaryo, P. A. W., Yuniar, I., Yuwono, P., & Setianingsih, E. (2023). Predictive Value of Non-Invasive Intracranial Pressure Monitoring in Profoundly Impaired Traumatic Brain Injury Patients. Babali Nursing Research, 4(4), 714–722. https://doi.org/10.37363/bnr.2023.44281
XVII. Wilde, E. A., Wanner, I.-B., Kenney, K., Gill, J., Stone, J. R., Disner, S., Schnakers, C., Meyer, R., Prager, E. M., Haas, M., & Jeromin, A. (2022). A Framework to Advance Biomarker Development in the Diagnosis, Outcome Prediction, and Treatment of Traumatic Brain Injury. Journal of Neurotrauma, 39(7–8), 436–457.
https://doi.org/10.1089/neu.2021.0099
XVIII. Wilson, L., Stewart, W., Dams-O’Connor, K., Diaz-Arrastia, R., Horton, L., Menon, D. K., & Polinder, S. (2017). The chronic and evolving neurological consequences of traumatic brain injury. The Lancet Neurology, 16(10), 813–825.