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.

This article was presented at NEUROTRAUMA 2022.

Conception and design were done by Mathew Joseph, Ananth P. Abraham, and Ganesh Swaminathan. Drafting of the article was done by Ganesh Swaminathan and Mathew Joseph. Statistical analysis was performed by Thenmozhi Mani. Mathew Joseph is the guarantor.

Article published online:
25 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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