Disability and quality of life in traumatic brain injury in Indonesia a prospective analysis of GCS scores, clinical and social factors in a 5-year cohort study

Abstract Background Traumatic brain injury (TBI) remains a major health concern in Indonesia, where the burden is strongly associated with motorcycle-related traffic accidents, limited neurocritical care facilities, and unequal access to rehabilitation. This study aimed to analyze clinical patterns, disability risk factors, and long-term quality of life outcomes in Indonesian TBI patients, with a focus on the role of Glasgow Coma Scale (GCS) scores, clinical predictors, and socioeconomic disparities. Methods A prospective cohort study was conducted at Hasan Sadikin Hospital, Bandung, from March 2021 to March 2025, involving 128 patients with moderate-to-severe TBI (GCS ≤ 12). Diagnosis was confirmed through cranial CT scans and clinical assessments. Data collection included baseline neurological evaluations (GCS, GOSE, MoCA), neuroimaging (CT/MRI), and biannual SF-36 quality-of-life surveys. Statistical analyses were performed using chi-square tests and effect size calculations with SPSS version 29. Results Low admission GCS scores (3–8) were the strongest predictor of long-term disability (74.2% of cases; p < 0.001), followed by diffuse axonal injury (DAI) ( p = 0.02) and comorbidities ( p = 0.03). Surgical intervention (70.3% of cases) did not significantly reduce disability risk compared to conservative management ( p = 0.16). At the five-year follow-up, patients with mild injuries (GCS 13–15) reported higher quality-of-life outcomes, particularly in the physical (mean = 79.1) and mental (mean = 80.4) domains. Socioeconomic disadvantages, limited neurocritical resources, and cultural stigma toward disability further contributed to poor recovery in severe TBI patients. Conclusions In Indonesia, initial injury severity (GCS 3–8), DAI, and comorbidities are major predictors of long-term disability. Higher GCS scores correlate with improved quality of life, highlighting the urgent need for road safety programs targeting motorcycle users, standardized time-sensitive clinical protocols, and integrated rehabilitation systems. Larger multicenter studies are warranted to provide broader national insights.