Score to scan: Is there a link between Glasgow Coma Scale score and CT neuroimaging findings in trauma?

Many South African peripheral medical centres lack direct access to CT scans or neurosurgery. The Glasgow Coma Scale (GCS), used with or without other findings, remains widely utilised in traumatic brain injury (TBI) assessments with lack of standardisation between centres. There is limited data from South Africa (SA) correlating GCS scores to CT imaging in TBI.

This study aimed to assess CT findings at various GCS levels to determine whether GCS was a reliable indicator for imaging and referral.

A retrospective review of 385 patients categorised with mild, moderate or severe TBI was performed. The initial non-sedated post-resuscitation GCS score and initial CT brain findings were compared using the chi-square and Fisher's exact tests.

Increased intracranial pressure and subdural haemorrhage occurred in 41.7% and 53.7% of patients with GCS 9-12, respectively, and 30.5% and 41.4% of patients with GCS 13-15, respectively. The highest incidence of depressed skull fractures (51.3%; 95% confidence interval [CI], 43.2-59.3%; p < 0.001) and pneumocephalus (25.6%; 95% CI, 42.2-56.4; p < 0.001) were reported in the CGS 13-15 category. Neurosurgical intervention was required in 83.2% and 73.0% of patients with GCS scores of 9-12 and 13-15, respectively.

The severe category of GCS predicts imaging and neurosurgery requirements while the mild to moderate categories underpredict the need for patient referral.

This study provides rationale for the development of a local, standardised assessment tool to guide referral of TBI patients for imaging in resource-limited settings.