Clinical Profile and Association Between Admission Glasgow Coma Scale and In-Hospital Mortality Among Children With...

Introduction Traumatic brain injury (TBI) is a leading cause of trauma-related morbidity and mortality in children worldwide, and injury patterns in low- and middle-income countries differ from those reported in high-income settings. Data from tertiary centres in central India remain limited. This study describes the clinical profile, management pattern, and in-hospital outcome of children admitted with head injury at a tertiary care centre and evaluates the association between admission Glasgow Coma Scale (GCS) and in-hospital mortality. Methods This retrospective observational study included 81 children admitted with head injury to the Department of Pediatric Surgery, Gandhi Medical College, Bhopal, India, between January 2026 and June 2026. Demographic details, mechanism of injury, clinical features at presentation, admission GCS, non-contrast computed tomography (NCCT) head findings, management type, length of hospital stay, and outcome were recorded from case records. The association between GCS severity and outcome was assessed using Fisher's exact test, the chi-square test, and the Mann-Whitney U test, with p < 0.05 considered significant. Results The mean age was 5.03 ± 3.31 years, with a male-to-female ratio of 1.53:1. Fall from height was the commonest mechanism (44 of 81, 54.3%), followed by road traffic accidents (17 of 81, 21.0%). Most children presented with mild head injury (GCS 13-15; 61 of 81, 75.3%); eight (9.9%) had severe injury (GCS ≤8). NCCT was performed in 78 of 81 children (96.3%); skull fracture (37 of 78, 47.4%) was the most common finding, followed by extradural hemorrhage (20 of 78, 25.6%) and subdural hemorrhage (18 of 78, 23.1%). Conservative management was employed in 79 of 81 children (97.5%), with two (2.5%) requiring operative intervention. Overall in-hospital mortality was 11.1% (9 of 81). On Fisher's exact test, children with mild GCS had significantly lower odds of death compared with the combined moderate-to-severe group used as the reference category (odds ratio, 0.03; 95% CI, 0.003-0.22; p = 0.00003); seven of eight children with severe GCS died, compared with one of 61 with mild GCS. Mean GCS was significantly lower among children who died than among those discharged (6.1 versus 14.0; Mann-Whitney U = 23.0; p = 0.00000024). Conclusions Pediatric head injury at this centre was predominantly mild and managed conservatively, with fall from height as the leading mechanism, consistent with other Indian series. Lower admission GCS was strongly associated with in-hospital mortality on unadjusted analysis. These findings are descriptive and hypothesis-generating within this cohort; larger, prospective, multicentric studies with multivariable analysis are needed to confirm this association and identify additional factors influencing outcome.