The "Talk and Die" phenomenon in traumatic brain injury: A meta-analysis

Abstract

Introduction: Risk factors for "Talk and Die" phenomenon following Traumatic Brain Injury (TBI) are poorly identified in literature, and studies attempting to identify those factors yielded conflicting results.

Aim: To provide level 1 evidence on the significance of potential risk factors predictive of "Talk and Die" phenomenon following TBI.

Methodology: A systematic review and meta-analysis were performed. A fixed effect model for age, admission Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS), and Injury Severity Score (ISS) parameters were performed.

Results: Of 35,582 patients analyzed, 2397 patients experienced the "Talk and Die" phenomenon. Absence of intracranial hematoma (OR=0.137, CI: 0.276-0.991, =0.047), Older age (Hedge's g=0.153, CI: 0.104-0.202, p < 0.001), lower GCS score (Hedge's g=-0.111, CI: 0.062-0.160, p < 0.001), lucid interval duration of ≥ 24 h (OR=4.176, CI: 2.806-6.215, p = 0.000), higher AIS scores (Hedge's g was 0.138, CI: 0.089-0.188, p < 0.001), and lower ISS scores (Hedge's g=0.137, CI: 0.088-0.186, p < 0.001) were identified as risk factors for mortality.

Conclusion: Considering our results and others, we conclude that absence or presence of intracranial hematomas, older age, lower GCS, lucid interval ≥ 24 h, High AIS, and low or high ISS predispose to a "Talk and Die" phenomenon following a Traumatic Brain Injury.

Keywords: Head Injury; Meta-analysis; Phenomenon; Talk and die; Traumatic brain injury.