Background: Traumatic brain injury (TBI) is the leading cause of mortality, morbidity, and disability globally. Methods for a reliable prediction of outcomes on the admission of TBI cases are of great clinical relevance to stakeholders.
Objectives: This study used the International Classification of Diseases-10 codes (S00-S09) for analysis of injury distribution of TBI patients and attempted to find the prognostic predictors of Glasgow coma scale (GCS) in the outcome from readily accessible parameters.
Methods: The data were reanalyzed from the Towards Improved Trauma Care Outcomes (TITCO) project from India. TITCO is the prospective, observational, multicenter trauma registry, contained data of trauma patients admitted to four public university hospitals in Mumbai, Delhi, and Kolkata collected from October 2013 to September 2015.
Results: Among 8525 cases under study, low GCS scores before admission, which was dependent on the demographic variables and related risk factors occurring at the time of injury, were important in the prognostic predictors of mortality. However, survival probability during hospitalization remained uniformly uncertain for the elderly. Death as outcome of injury was dependent on the average intensity of injury, GCS on admission, critical injury severity score, and intubation within 1 h of admission and between 1 and 24 h of admission. These factors emerged as the independent predictors of fatality. The time of the day of injury did not yield any significant association with low GCS or demise in our study.
Conclusions: GCS <8, i.e., severe at the time of admission, was an unfavorable predictor of in-hospital mortality.
Keywords: Glasgow coma scale; injury severity score; outcome assessment; traumatic brain injury.
Conflict of interest statement
There are no conflicts of interest.
Analysis of Long-Term (Median 10.5 Years) Outcomes in Children Presenting With Traumatic Brain Injury and an Initial Glasgow Coma Scale Score of 3 or 4DH Fulkerson et al. J Neurosurg Pediatr 16 (4), 410-9. PMID 26140392.In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more …
Using the Abbreviated Injury Severity and Glasgow Coma Scale Scores to Predict 2-week Mortality After Traumatic Brain InjurySD Timmons et al. J Trauma 71 (5), 1172-8. PMID 22071922.Anatomic and physiologic scales are useful in the prediction of mortality after TBI. We did not demonstrate any added benefit to combining the total GCS or GCS Motor Scor …
The Effect of Age on Glasgow Coma Scale Score in Patients With Traumatic Brain InjuryK Salottolo et al. JAMA Surg 149 (7), 727-34. PMID 24899145.Age affects the relationship between the GCS score and anatomic TBI severity. Elderly TBI patients have better GCS scores than younger TBI patients with similar TBI sever …
EpidemiologyP Leo et al. PMID 26583186. - ReviewTraumatic brain injury (TBI) is an important public health concern that is one of the leading causes of death and disability annually around the world., Several factors h …
Pathophysiology of Mild TBI: Implications for Altered Signaling PathwaysRA Laskowski et al. PMID 26269903. - ReviewConcussions and mild traumatic brain injury (TBI) represent a substantial portion of the annual incidence of TBI aided by the increased reporting of concussions in youth …
- Fàbregas N, Gambús PL, Valero R, Carrero EJ, Salvador L, Zavala E, et al. Can bispectral index monitoring predict recovery of consciousness in patients with severe brain injury? Anesthesiology. 2004;101:43–51. - PubMed
- Mahdian M, Fazel MR, Fakharian E, Akbari H, Mahdian S. Cerebral state index vs Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients. Chin J Traumatol. 2014;17:220–4. - PubMed
- Myles PS, Daly D, Silvers A, Cairo S. Prediction of neurological outcome using bispectral index monitoring in patients with severe ischemic-hypoxic brain injury undergoing emergency surgery. Anesthesiology. 2009;110:1106–15. - PubMed
- Nickson C. Traumatic Brain Injury (TBI) Prognosis. LITFL Life in the Fast Lane Medical Blog. 2013. [Last updated 2018 May 06; cited Jun 2018 Jun 10]. Available from: https://lifeinthefastlane.com/ccc/traumatic-brain-injury-tbi-prognosis/