Integrated Role of GCS and eTBI Scores in Outcome Stratification for Traumatic Brain Injury in the Elderly

Elderly patients with traumatic brain injury (TBI) often exhibit atypical responses owing to age-related frailty and comorbidities. Although the Glasgow Coma Scale (GCS) is widely used for initial neurological assessment, it may be insufficient for accurate prognostication in geriatric populations. The elderly TBI (eTBI) score, which integrates clinical and laboratory markers, provides a broad evaluation framework and may enhance prognostic accuracy in conjunction with GCS. To evaluate the utility of combined GCS and eTBI scores in predicting 30-day functional outcomes in TBI patients aged 60 years or above.

A prospective observational study was conducted in 75 elderly patients with TBI admitted to the Sheri Kashmir Institute of Medical Sciences between April 2024 and March 2025. Clinical data were collected at admission and patients were stratified into risk categories using their eTBI scores. Functional outcomes were assessed after 30 days using the Glasgow Outcome Scale (GOS). Correlation analysis and ordinal logistic regression were employed to evaluate predictive accuracy.

GCS showed a strong correlation with 30-day GOS (ρ=0.823, p<0.001), while eTBI exhibited a moderate to strong correlation (ρ=0.648, p<0.001). Both were independent predictors in logistic regression analysis: GCS score (odds ratio [OR], 1.85) and eTBI (OR, 1.32). The combined model (GCS + eTBI) improved predictive power (Nagelkerke R²=0.71) compared to GCS alone (R²=0.67, p=0.002). High-risk patients showed an 80% mortality rate, whereas low-risk patients achieved a 51.1% rate of good recovery.

Although GCS remains a strong standalone predictor, integrating eTBI enhances prognostic accuracy, especially in borderline cases. This combined approach enables better risk stratification and clinical decision making in geriatric patients with TBI.