Factors Associated with Mortality and Functional Outcome in Severe Traumatic Brain Injury (GCS ≤ 8) Patients: A Prospective Cohort Study

Abstract Severe traumatic brain injury (TBI) is associated with high mortality and long-term disability. We evaluated clinical, radiological, and laboratory factors associated with outcome in severe TBI. This prospective cohort study included 280 patients with severe TBI, defined as Glasgow Coma Scale (GCS) ≤8, admitted between December 2020 and December 2022. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) and dichotomized as unfavorable (GOS 1–3) or favorable (GOS 4–5). Mortality was analyzed separately. Multivariable binary logistic regression was used to identify factors associated with unfavorable outcome. Mean age was 39.1 ± 16.8 years; median age was 38 years (interquartile range [IQR], 27.0–49.3). Unfavorable outcome occurred in 208 patients (74.3%). Mortality by last recorded follow-up was 55.0% (154/280), including 117 in-hospital and 37 post-discharge deaths. On multivariable analysis, absence of prehospital care (adjusted odds ratio [aOR]: 3.14, 95% confidence interval [CI]: 1.44–13.95), pupillary asymmetry (aOR: 4.26, 95% CI: 1.58–10.75), anemia (aOR: 3.00, 95% CI: 1.10–7.68), associated injury (aOR: 6.92, 95% CI: 2.81–20.64), lower admission GCS, and Marshall computed tomography (CT) categories V and VI were associated with unfavorable outcome. Severe TBI had high mortality and disability. Lower GCS, absence of prehospital care, pupillary asymmetry, anemia, associated injury, and Marshall CT categories V and VI were independently associated with unfavorable outcome.