Prognostic Relationship of Glasgow Coma Scale, Revised Trauma, and Cranial Computerized Tomography Scores in Traumatic Brain Injury.

Abstract

BACKGROUND: Traumatic brain injury (TBI) is heterogeneous clinical entity that is a global burden in surgical emergencies, and a major cause of
mortality and morbidity in young adults. Prognosis of TBI is dependent on patients' clinical features and extent of brain injury. This study aims to evaluate
the relationship between Glasgow Coma Scale (GCS), Revised trauma score (RTS), Computerized Tomographic (CT) scan scores (using the Marshall,
Rotterdam and the Helsinki CT scale), and determine if any the effect of these scores on the prognosis of patients with TBI in the acute setting.
METHODOLOGY: This study was a prospective longitudinal study conducted on hospitalized patients with Traumatic Brain Injury. Patients without
cranial CT were excluded. The severity of the traumatic brain injury was assessed after resuscitation by using the GCS and cranial CT. The biodata of all
patients were documented in a pro forma form including the indices studied-generated RTS, GCS scores, skull base fracture, Marshall, Rotterdam and
Helsinki CT scores, and outcome using the 5-level Glasgow outcome score. We compared groups using chi-square, Fisher exact test, and t-test as
appropriate. Signiï€cance was judged at the p<0.05 level. Statistical analyses were employed using IBM SPSS Statistics for Windows and Mac, Versions
22.0 (IBM, Armonk, NY).
RESULTS: We studied 68 patients, 57 males and 11 females (M: F= 5.2:1). The mean age was 30.8 years (1.5-80 years). The GCS score was associated
signiï€cantly with TBI outcome (p= 0.015) just like and Helsinki CT score (p=0.031). However, gender (p=0.332), the RTS (p=0.105), skull fracture
(p=0.207), Marshall (p=0.396) and Rotterdam CT score (p=0.776) were not signiï€cantly associated with TBI outcome. The Odds Ratio (OR) of a
patient with severe TBI dying was 8.33 (95% CI: 1.363 to 50.949) compared to those without severe TBI with OR of 0.12 (95% CI: 0.019 to 0.733)
Conclusion: The GCS score and Helsinki CT scores are good prognostic scores to use in determining whether a patient will survive a TBI in the acute
phase. The lack of correlation between the various means of assessing TBI used in this study suggests that clinical parameters must still be used in
conjunction with CT ï€ndings in the management of TBI.