Comparative Performance of Clinical Scoring Systems for Early Mortality Prediction in Blunt Traumatic Brain Injury

Abstract Background Early and accurate risk stratification in patients with blunt traumatic brain injury (TBI) is essential for optimizing clinical triage, resource allocation, and neurocritical care management. Although numerous clinical scoring systems exist, their comparative prognostic performance for predicting early mortality remains inadequately defined in dedicated neurotrauma cohorts. Methods This single-center retrospective observational cohort study evaluated 444 adult patients admitted to the intensive care unit with blunt TBI between March 2022 and March 2025. The discriminative performance of five clinical scoring systems including the Glasgow Coma Scale (GCS), Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score, Revised Trauma Score (RTS), Modified Early Warning Score (MEWS), and Rapid Emergency Medicine Score (REMS) for predicting 24-hour mortality was assessed using receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) comparisons, and Youden Index-derived optimal cutoffs. Results Within the cohort, the 24-hour mortality rate was 21.8% (n = 97). The Revised Trauma Score (RTS) demonstrated the highest discriminative accuracy (AUC = 0.676, 95% CI: 0.617–0.737), followed closely by GCS (AUC = 0.669, 95% CI: 0.608–0.727) and MGAP (AUC = 0.657, 95% CI: 0.594–0.724). Trauma-specific and neurological scoring systems (RTS, GCS, and MGAP) significantly outperformed the general emergency score REMS (AUC = 0.601, p < 0.05). The Modified Early Warning Score (MEWS) yielded an intermediate AUC of 0.651. Pairwise comparisons revealed no statistically significant differences among RTS, GCS, and MGAP, whereas trauma-oriented scores demonstrated superior prognostic validity over general emergency indices. Conclusions Trauma-specific and neurological scoring systems provide superior prognostic accuracy compared with general emergency scores for predicting early mortality in blunt TBI. Nevertheless, the moderate overall performance of all evaluated tools highlights the limitation of static admission variables in capturing the dynamic pathophysiology of secondary brain injury. Future prognostic models should integrate clinical scoring with advanced radiological metrics and physiological time-series data to refine individualized neurotrauma outcomes.