PONE-D-21-10673

Incidence and Predictors of Mortality among patients with head injury admitted to Hawassa University Comprehensive Specialized Hospital in southern Ethiopia, 2020

PLOS ONE

Dear Dr. Assele,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Kind regards,

Hans-Peter Simmen, M.D., Professor of Surgery

Academic Editor

PLOS ONE

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2. Thank you for including your ethics statement: "Ethical clearance was obtained from the ethical review committee of the College of Health Sciences of Wolaita Sodo University, and permission was obtained from Hawassa University Comprehensive Specialized Hospital. "

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I read your work with great interest. At present TBI is one of the most important topics when dealing with trauma-patients all around the world.

Here I have gathered a few general remarks regarding your manuscript:

- When using the term "polytrauma" you do not give the definition used at your institution to classify patients as polytraumatised. Since the definition in use can have relevant influence on the prognosis of the treated patients you should clarify this issue.

- You do not mention the time from trauma to start of treatment of your patients nor do you give the amount of time they suffered from conditions like hypoxaemia, hypothermia etc. - this would be of great importance to put your findings into perspective.

- In your section "Incidence of mortality and survival status" you report on the overall follow-up of all of your patients but do not give the follow-up regarding e.g. different severities of TBI. Such a division into subgroups would greatly improve the relevance of your manuscript.

In this section I also found the following sentence: "(Error! Reference source not found.)". Please clarify!

In the same section you state "patients who had underwent surgery had higher mean survival time when compared to those did not undergone surgery (sic)". But you do not go into detail regarding the underlying pathologies as well as the characteristics of patients receiving operative or conservative treatment. You rightly mention this flaw in your discussion but do not give any further details.

- The allover quality of your manuscript would benefit greatly from proofreading by an english native speaker (as one of many possible examples I would like to mention the use of "causality" in stead of - I suppose - "casualty" in your sections about "Management related findings" and "Incidence of mortality and survival status" or the sentence "The risk of death hyperthermic patients was 1.8 (AHR: 1.8; 95% CI= 1.23– 2.63) times higher than those with normothermic patients (Table 4)." found in your "Assessment of model adequacy").

Only after thorough revisions of your manuscript I would deem it eligible for PLOS ONE.

Reviewer #2: Dear Authors,

thank you very much for submitting for manuscript. Doing research to improve patients' treatment and outcomes especially in the presence of limited resources is very impressive and you have collected a lot of important data on your patients. However I cannot recommend publication of the manuscript in its current form.

- Language of the manuscript needs significant improvement to make it more understandable

- Variables should be shown in a separate table

- Data on follow-up should be added

- Why did you limit the patient sample to 1220 if you had more patients?

- Secondary injury being a major contributor of bad outcomes has long been known.

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Reviewer #1: No

Reviewer #2: No

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Incidence and predictors of mortality among patients with head injury admitted to Hawassa University Comprehensive  Specialized Hospital, Southern Ethiopia: A retrospective follow-up study

PONE-D-21-10673R1

Dear Dr. Assele,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Hans-Peter Simmen, M.D., Professor of Surgery

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: