Abstract
Objective We study the clinical relevance of classifying traumatic brain injury (TBI) into
moderate and mild categories based on the Glasgow Coma Scale (GCS) score at admission
with respect to the treatment intensity and 6-month mortality and morbidity rates.
Methods Analysis of patients from a prospectively maintained database admitted at a level
I trauma center from 2013 to 2019 with an admission GCS score between 9 and 15 and
a minimum follow-up of 6 months post-TBI was done to study the treatment intensity
and 6-month morbidity and mortality rates for each GCS score from 9 to 15.
Results In all, 2,060 patients met the study criteria, of which 1,684 were males (81.7%).
Road traffic accident was the most common cause of TBI (83.7%). There was a significant
linear increase in the proportion of patients who had good outcomes with increasing
GCS scores from 9 to 15 (p ≤ 0.001). When the variables in each GCS score were compared with a GCS score of
15, there was an increase in the odds ratio of mortality and poor outcome with decreasing
GCS scores (p ≤ 0.001). Patients with a lower admission GCS score required more intense treatment
in the form of surgery and ventilation (p ≤ 0.00001). There was a higher incidence of pupillary asymmetry in patients with
lower GCS scores (p ≤ 0.00001).
Conclusions The classification of TBI patients into moderate and mild based on the GCS score
at admission is not of any practical value, and TBI patients may be more usefully
classified based on the admission GCS score into severe and not severe groups.
Keywords
TBI classification - GCS score - outcomes - mild and moderate TBI - GOS-E
