Correlation between Glasgow Coma Scale Pupil Score and Brain Computed Tomography Scan Findings in Head Trauma Patients

BACKGROUND: Traumatic brain injury is a leading cause of morbidity and mortality worldwide, necessitating rapid neurological assessment for early triage and management. The Glasgow Coma Scale-Pupils (GCS-P) score integrates the GCS with pupillary reactivity to improve the prediction of intracranial injury severity. This study aims to examine the correlation between GCS-P scores at presentation and brain CT findings in patients with head trauma, particularly in a semi-urban Indian emergency setting where CT access is often delayed, to validate GCS-P as a practical triage tool in the resource-limited environments. MATERIALS AND METHODS: This retrospective study enrolled 300 adult patients with acute head injuries presenting over 3 months. Patients underwent standardized neurological evaluation including GCS and pupillary assessments followed by noncontrast CT imaging within 2 h. The GCS-P score was computed by subtracting the pupil reactivity score from total GCS. CT findings were categorized by injury severity (normal, mild, moderate, and severe). Spearman's rank correlation analysis assessed the relationship between GCS-P scores and CT severity. RESULTS: The mean age was 37.6 ± 15.8 years; 79.3% were male, and road traffic accidents were the predominant trauma mechanism (67%). The mean GCS-P score was 10.7 ± 3.9. CT scans revealed severe injury in 23.3% of cases. A strong negative correlation existed between GCS-P score and CT severity (ρ = -0.682, P < 0.001). Patients with severe CT findings had significantly lower GCS-P scores (5.9 ± 2.4) than those with mild (12.4 ± 2.1) or normal imaging (14.0 ± 1.6) (P < 0.001). CONCLUSION: GCS-P is a reliable, practical tool for the early identification of severe intracranial injury, with a strong association with CT severity. Routine implementation of GCS-P scoring can enhance triage, neurosurgical decision-making, and resource allocation in emergency neurotrauma care. Further multicenter studies with long-term outcomes are warranted.