Incidence and predictors of mortality among traumatic brain injury patients in Ethiopia: a systematic review and meta-analysis

Purpose Traumatic brain injury (TBI) represents a significant public health concern due to its high incidence, substantial prevalence of chronic neuropsychiatric sequelae, disabilities, and economic burdens. Although several primary studies have examined mortality rates among individuals with TBI in Ethiopia, no systematic reviews and meta-analyses have yet synthesized these findings to provide a comprehensive nationwide estimate. Methods A systematic search for Ethiopian TBI mortality studies was conducted using PubMed, MEDLINE, Hinari, ScienceDirect, Ovid, the Web of Science, the Directory of Open Access Journals, and the African Journals Online. Following the PRISMA guidelines, we screened eligible studies, assessed quality with the Joanna Briggs Institute tool, and analyzed data in Stata ver. 18. A random-effects model estimated TBI mortality and the pooled odds ratios (PORs) of predictors. Heterogeneity (I2) was assessed, and subgroup analyses, meta-regression, forest plots, and funnel plots with Egger and Begg tests addressed variability and publication bias. Results Of 100 records, 23 studies (n=7,866) met inclusion. The pooled incidence of mortality from TBI in Ethiopia was 15.69% (95% confidence interval [CI], 12.41–18.96). Regional incidence varied from 3.15% (95% CI, 1.23–5.08) in the Sidama Region to 39.42% (95% CI, 33.25–45.59) in the Amhara Region. Identified predictors of mortality included aspiration pneumonia (POR, 10.41; 95% CI, 3.25–33.40), penetrating injury (POR, 1.76; 95% CI, 1.07–2.90), road traffic accident injuries (POR, 1.71; 95% CI, 1.11–2.64), severe Glasgow Coma Scale (GCS) scores (POR, 18.94; 95% CI, 7.37–48.7), moderate GCS scores (POR, 2.95; 95% CI, 1.60–5.44), bilateral pupillary reaction (POR, 24.56; 95% CI, 7.72–78.19), unilateral pupillary reaction (POR, 7.75; 95% CI, 4.45–13.48), hypoxia (POR, 8.22; 95% CI, 2.42–27.98), concomitant injuries (POR, 2.15; 95% CI, 1.05–4.38), complications (POR, 4.76; 95% CI, 2.49–9.09), surgical management (POR, 0.58; 95% CI, 0.36–0.94), and mechanical ventilation (POR, 4.45; 95% CI, 2.00–9.88). Conclusions The high TBI mortality in Ethiopia underscores the urgent need to expand advanced trauma care centers, deploy trained personnel beyond urban areas, and strengthen road safety policies to achieve Sustainable Development Goal targets by 2030.