Unfavorable Prognostic Predictors of Traumatic Brain Injury Patients in Asia: A Systematic Review Elizabeth Marcella , Michelle Imanuelly 1Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia INTRODUCTION Traumatic brain injury (TBI) is a ‘silent epidemic’, the main cause of hospitalization, death, and disability more than any other traumatic insult in the world. Surprisingly, TBI burden study in Asia is the highest compared to all other global regions due to TBIrelated outcomes as a result of falls (77%) and other intentional injuries. Currently, no study has comprehensively reviewed the factors related to TBI prognostic specifically in Asian settings, though such review is desperately needed considering the high Road Traffic Injury (RTI) induced TBI prevalence in Asian population. MATERIALS AND METHODS A systematic review was conducted through PubMed, Scopus, and CENTRAL, searching for cohort studies which analyze factors contributing to related with unfavorable prognosis of TBI Patients in Asia. Studies selected were then assessed for bias risk with STROBE’s criteria. CONCLUSIONS To conclude, the factors associated with unfavorable prognosis of traumatic brain injury patients in Asian countries are Age, Gender, Glasgow Coma Scale (GCS), neurological comorbidity, pH bleeding, pH respiratory distress, raised intracranial pressure (ICP), hypotension/ blood pressure, heart rate, hypoxia, and motor response. Future evaluation of current triage criteria in ED is hoped to establish the updated triage system in clinical setting, thereby helping to reduce the unfavorable prognosis of TBI patients in Asian countries. RESULTS AND DISCUSSIONS The search yielded seven studies with a total of 1,940 subjects, consisting 6 cohort studies. Sociodemographic factors and clinical factors are two categories of factors associated with unfavorable prognosis of traumatic brain injury patients in Asian countries. The most consistent factors are age, GCS Score, and neurological comorbidity. Author and Year (STROBE’s score) Study Design Study Population and Location Predictor and Predicted P value Outcome Ram et al, 2019 (_/22) Cohort Prospective ( May to October 2017), data obtained from medical records 447 adult patients with TBI in King George Hospital, India GCS, neurological injury, pH bleeding, pH respiratory distress. Lower GCS and presence of neurological injury, pH bleeding, and pH respiratory distress are indicative of unfavorable prognosis. GCS <0.05, neurological injury <0.05, pH bleeding <0.05, pH respiratory distress <0.05 Lee et al, 2019 Cohort Retrospective (June 2011 to January 2017), data obtained from patients’ medical records 43 pediatric TBI patients in the National University Hospital of Singapore Raised ICP and hypotension indicates unfavorable prognosis. Raised ICP 0.008, hypotension 0.010 Ziaeirad et al, 2018 (_/22) Cross-sectional, retrospective study (March 20, 2014 to March 19, 2015), data obtained from medical records 267 adult patients with severe TBI in three trauma centres of Isfahan University of Medical Sciences (IUMS) Age, gender, GCS, Pupillary reflex, Hypernatremia, Raised ICP. Older age, male, lower GCS, abnormal pupillary response, hypernatremia, and raised ICP means unfavorable prognosis. Age 0.001, gender 0.0054, GCS 0.001, Pupillary reflex 0.0005, Hypernatremia 0.0185, Raised ICP 0.0447 Okazaki et al, 2016 (_/22) Cohort Retrospective (January 1, 2008 to October 31, 2015), data obtained from medical records 140 Patients ≥65 years old with severe TBI in Kagawa University Hospital CCI, Age, GCS, Pupillary response, neurological deficit. Older age, lower GCS, abnormal pupillary response, and the presence of neurological disorder indicates unfavorable prognosis. CCI 0.01, age <0.01, GCS <0.01, Pupillary response <0.001, neurological deficit <0.001 Park et al, 2009 (_/22) Cohort Prospective (December 2004 to March 2006), data obtained from initial clinico-radiological data. 115 TBI Patients in Korea Age, GCS, Pupillary response, neurological deficit, systolic blood pressure, heart rate, motor response. Older age, lower GCS, abnormal pupillary response, presence of neurological deficit, hypotension, and bad motor response indicates unfavorable prognosis Age <0.001, GCS <0.001, pupillary response <0.001, neurological deficit <0.001, systolic blood pressure <0.05, heart rate 0.05, motor response <0.05 Oh HS et al, 2006 (_/22) Cohort Prospective (1and 6- months period), data obtained from medical records 82 TBI patients in Neurological Intensive Care Unit at a university hospital Age <0.05, intracranial hematoma <0.05, systolic blood pressure <0.05, heart rate 0.05, motor response <0.05 Jiang et al, 2002 (_/22) Cohort Retrospective 846 Patients in China (January 1991December 1998), data obtained from medical records Age, intracranial hematoma, systolic blood pressure, heart rate, motor response. Older age, presence of intracranial hematoma, low blood pressure/ hypotension, and bad motor response were indicative of unfavorable prognosis. 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