Identification of Predictors of Early TBI Outcome Beyond the Initial Glasgow Coma Scale: A Prospective Cohort Study

Abstract To identify factors associated with early unfavorable functional outcome in a Colombian cohort with traumatic brain injury (TBI), moving beyond the initial Glasgow Coma Scale (GCS) to validate a multidimensional prognostic approach. A prospective cohort study was conducted at a tertiary hospital in Colombia from July 2024 to January 2025. We included consecutive patients > 16 years with TBI referred to neurosurgery. Clinical, demographic, and radiological data were collected. The primary outcome was an unfavorable functional outcome at one-month post-discharge (Glasgow Outcome Scale-Extended ≤ 4). Multivariable Firth-penalized logistic regression was used to identify independent predictors. Among 452 enrolled patients (median age 45.7 years, 72.6% male), road traffic accidents were the predominant mechanism of injury (65.5%). Most TBIs were mild (75.4%) based on initial GCS. At one-month follow-up (n = 404), 134 patients (33.2%) had an unfavorable outcome. In the multivariable model, initial GCS severity was not an independent predictor. The independent factors for an unfavorable outcome were: age ≥ 60 years (odds ratio [OR] = 5.03), pupillary unreactivity (OR = 7.45), requirement for intubation (OR = 6.06), subarachnoid hemorrhage (OR = 4.00), lower limb fracture (OR = 6.30), closed abdominal trauma (OR = 5.25), cervical spine fracture (OR = 6.87), pneumonia (OR = 8.95), and hypernatremia (OR = 5.20). Early functional outcome after TBI was not independently predicted by the initial GCS but by a multidimensional set of factors including age, neurological severity, neuroimaging, extracranial injuries, and complications. These findings validate the CBI-M framework and support comprehensive assessment for TBI prognosis.