Factors Associated With Poor One-Month Glasgow Outcome Scale Scores After Traumatic Brain Injury With Intracranial...

Traumatic brain injury (TBI) is a major public health concern in Thailand, contributing to substantial morbidity and mortality. This study aimed to identify prognostic factors associated with poor Glasgow Outcome Scale (GOS) scores 1 month after TBI with intracranial hemorrhage (ICH). This is particularly relevant in the emergency department (ED), where early decisions regarding triage, monitoring, and disposition must be made rapidly.

We conducted a retrospective cohort study at Ramathibodi Hospital, Bangkok, Thailand, including trauma patients aged ≥ 15 years with TBI and ICH who presented to the ED between 2020 and 2022. Outcomes were categorized into three groups based on the 1-month GOS: unfavorable (GOS 1-2), intermediate (GOS 3-4), and favorable (GOS 5). Clinical factors and CT findings were analyzed using multivariable ordinal logistic regression to identify factors associated with poor GOS scores across these groups.

A total of 227 patients were included in the study. Among them, 31 patients (13.6%) were in the unfavorable group, 81 patients (35.7%) in the intermediate group, and 115 patients (50.7%) in the favorable group. Factors associated with poorer outcomes included elderly patients (age ≥ 65 years) (multivariable odds ratio [mOR] 5.25, 95% confidence interval [CI] 2.33-11.85), low initial systolic blood pressure (SBP < 100 mmHg) (mOR 4.38, 95% CI 1.02-18.86), and initial glasgow coma scale (GCS) scores: severe vs. mild (mOR 49.88, 95% CI 14.26-174.44) and moderate vs. mild (mOR 12.26, 95% CI 3.86-38.98). Other factors included slight pupillary reaction (mOR 8.36, 95% CI 1.76-39.67), although this finding should be interpreted cautiously due to the small number of abnormal observations and wide CIs, as well as subdural hematoma (SDH) (mOR 3.10, 95% CI 1.53-6.25) and midline shift or brain herniation (mOR 4.41, 95% CI 1.84-10.57).

These factors were associated with poorer 1-month GOS scores and may support early risk stratification in adult TBI patients with traumatic ICH.