Retrospective Evaluation of Integrated Glasgow Coma Scale and CT Scan Results for Predicting Traumatic Brain Injury Outcomes in An Indian Tertiary Care Hospital

Background: Traumatic Brain Injury (TBI) is an important global health issue, especially in developing countries like India. Accurate prediction of TBI is crucial for guiding treatment choices. The Glasgow Coma Scale (GCS), and brain Computed Tomography (CT) scores have been associated with clinical outcomes in TBI patients. However, no study has used the combination of GCS score and CT scan results to predict the outcomes of TBI in Indian patients. Therefore, we aimed to investigate the association of GSC score and CT results with TBI outcomes when used in combination and alone. Methods: This study retrospectively analyzed data of one hundred twenty TBI patients of SMS Hospital, Jaipur. The GCS deficit score was computed by subtracting the GCS score from fifteen. The midline shift, basal cistern compression and lateral ventricular compression presence were scored as 1 to calculate the mass effect CT score. The sum of mass effect CT score and Subarachnoid Hemorrhage (SAH) presence, valued as 2, determined the prognostic CT score. The CT-GCS deficit score was the sum of the GCS deficit and prognostic CT score. Results: Higher CT-GCS deficit score (13.5±3.2) was observed in-hospital mortality patients compared to survivors (8.9±3.4; Cohen d=1.3). Surgical decompression was more frequent with a higher mass effect score (2.8±0.5; Cohen d=1.4). The inability to follow commands at hospital discharge was associated with higher CT-GCS deficit scores (13.3±3.2; Cohen d=1.06). At three months, patients not following commands had significantly higher CT-GCS deficit scores (13.6±3.1; Cohen d=0.94). Logistic regression confirmed the CT-GCS deficit score as a strong predictor for all outcomes except for surgical decompression. Conclusion: The CT-GCS deficit score is associated with in-hospital mortality and the inability to follow commands at discharge and post-discharge, indicating its potential to enhance prognostic accuracy and guide treatment decisions, particularly in resource-limited settings like India. Further prospective studies with larger sample sizes are recommended for validation and applicability.