ASA score is an independent predictor of 1-year outcome after moderate-to-severe Traumatic Brain Injury

Abstract Introduction Traumatic brain injury (TBI) remains a critical challenge in polytrauma management, with mortality frequently attributed to the brain injury itself. While current prognostic models like IMPACT provide valuable insights, they inadequately capture outcome variability. This study investigates whether incorporating the American Society of Anesthesiologists (ASA) score and Trauma and Injury Severity Score (TRISS) as additional metrics improves long-term outcome prediction in moderate-to-severe TBI (msTBI) patients. Method We retrospectively analyzed data from 720 msTBI patients treated between 2005-2021. Patient information—including ASA score, Glasgow Coma Scale (GCS), age, and polytrauma indicators—was collected from institutional trauma registries. The primary endpoint was 1-year Glasgow Outcome Scale (GOS), with 90-day mortality as a secondary measure. Logistic regression assessed the predictive values of ASA score and TRISS as independent additions to established prognostic frameworks. Result Among the cohort, 35% presented with polytrauma. Unfavorable outcomes (GOS 1-3) occurred in 51% of cases, with a 90-day mortality rate of 19%. Key outcome predictors included age, ASA score, GCS, TRISS, and pupillary reaction. Adding the ASA score to the prognostic model significantly enhanced predictive performance. Discussion Our findings suggest that TRISS retains critical prognostic metrics even in TBI populations, and that pre-injury health—as measured by the ASA score—is independently associated with outcomes. This indicates that factors beyond age play a crucial role in patient prognosis. With further validation, these insights could support more precise resource allocation and tailored clinical management, although additional prospective research is needed to confirm these results.