Early Neurological Deterioration and Admission CT Predictors of Emergency Neurosurgical Intervention and Short-Term Outcomes in Acute Traumatic Brain Injury: A Prospective Observational Cohort Study

Background: Early identification of patients with traumatic brain injury (TBI) who are at risk of requiring emergency neurosurgical intervention is essential for timely escalation of care. Objective: To evaluate whether early neurological deterioration and admission CT characteristics could predict emergency neurosurgical intervention and short-term clinical outcomes in patients with acute TBI. Methods: A prospective observational cohort study included 272 adults presenting with acute TBI. Demographic, injury-related, physiological, neurological, and CT characteristics were recorded prospectively. Early neurological deterioration included worsening GCS motor score, new or worsening pupillary abnormality, new focal motor deficit, or herniation/Cushing response. The primary outcome was emergency neurosurgical intervention. Results: Emergency neurosurgical intervention was required in 34 patients (12.5%). Patients undergoing intervention had lower admission GCS [8.0 (IQR 7.0–14.0) vs. 15.0 (13.0–15.0); p<0.001], more frequent severe TBI (52.9% vs. 8.4%), midline shift >5 mm (44.1% vs. 5.9%), basal cistern compression (32.4% vs. 5.5%), and early neurological deterioration (58.8% vs. 6.3%); all p<0.001. Neurosurgical intervention occurred in 57.1% of patients with early deterioration versus 5.9% without deterioration (p<0.001). Neuroworsening was also associated with higher ICU admission, mechanical ventilation, radiological progression, mortality, and unfavourable discharge GOS. On multivariable analysis, early neurological deterioration independently predicted neurosurgical intervention (aOR 7.22, 95% CI 2.55–20.39) and unfavourable discharge outcome (aOR 5.00, 95% CI 1.93–12.95). Conclusion: Early neurological deterioration, particularly when accompanied by severe GCS impairment and CT evidence of mass effect, is strongly associated with emergency neurosurgical intervention and poorer short-term outcomes after acute TBI.