Evaluating the predictive factors affecting outcome in patients with severe traumatic brain injury: a prospective observational study

Vikram Singh, Amar Nath, Meenu Beniwal, Paritev Singh, Rockey Dahiya


Background: Severe traumatic brain injury (TBI) is a neurosurgical emergency and timely intervention is critical for favorable outcome. We aimed to evaluate certain demographic, clinical and radiological factors for outcome prediction in TBI patients in terms of morbidity and mortality.

Methods: A prospective observational study was conducted in 100 patients of severe TBI admitted to our hospital from September 2016 to June 2018. Those with penetrating head injury, associated severe chest, abdominal or orthopedic trauma and pregnant or lactating women were excluded. Clinical outcome was assessed at the time of discharge and after three months according to Glasgow outcome score (GOS).

Results: Majority of patients were adults in the age group 20 to 39 years. Road-side accident (75%) was the commonest mode of injury followed by fall (23%) and assault (2%). Out of 100 patients, 51 had in-hospital mortality. Of 49 patients who survived for GOS assessment at 3 months, three (6.1%) patients had unfavourable GOS I to III. Presence of hypoxemia, pupil non-reactivity, computerised tomography (CT) head findings of hemorrhagic contusion, subarachnoid hemorrhage (SAH), midline shift and effacement of basal cisterne were associated with significantly increased risk of unfavorable early and late outcome after severe TBI (p<0.05). Poor GCS score and fracture skull were associated with adverse early and late outcome respectively (p<0.001).

Conclusions: Low GCS score at admission, pupil non reactivity, presence of hypoxemia, abnormal CT head findings (hemorrhagic contusion, SAH, midline shift and effacement of basal cisterne) were strong predictors of adverse outcome after severe TBI.


Outcome prediction, Traumatic brain injury, Glasgow outcome score

Full Text:



Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2010. Accessed on

Rejeb I, Chakroun O, Chtara K, Boujelbene M, Ksibi H, Chaari A et al. Factors predicting early outcome in patients admitted at emergency department with severe head trauma. Journal of Acute Disease. 2015;4(1):68-72.

Menon DK, Schwab K, Wright DW, Maas AI. Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91(11):1637-40.

Pang BC, Kuralmani V, Joshi R, Hongli Y, Lee KK, Ang BT et al. Hybrid outcome prediction model for severe traumatic brain injury. J Neurotrauma. 2007;24(1):136-46.

Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I et al. Effects of gender on outcomes after traumatic brain injury. J Trauma 2011;71(6):1620-6.

Navdeep S, Vikas R, Yashbir D, Sarvpreet G. Factors predicting outcome in patients with severe head injury: Multivariate analysis. The Indian journal of Neurotrauma. 2012;9:45-48.

Leitgeb J, Mauritz W, Brazinova A, Majdan M, Wilbacher I. Outcome after severe brain trauma associated with epidural hematoma. Arch Orthop Trauma Surg. 2013;133(2):199-207.

Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S et al. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients. BMJ. 2008;336:425-9.

Chi JH, Knudson MM, Vassar MJ, McCarthy MC, Shapiro MB, Mallet S et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: A prospective multicenter study. J Trauma. 2006;61(5):1134-41.

Husson EC, Ribbers GM, Willemse-van Son AH, Verhagen AP, Stam HJ. Prognosis of six-month functioning after moderate to severe traumatic brain injury: a systematic review of prospective cohort studies. J Rehabil Med. 2010;42(5):425-36.

Skolnick BE, Maas AI, Narayan RK, Van der Hoop RG, MacAllister T, Ward JD et al. SYNAPSE Trial Investigators. A clinical trial of progesterone for severe traumatic brain injury. N Engl J Med. 2014;371(26):2467-76.

Murray GD, Butcher I, McHugh GS, Lu J, Mushkudiani NA, Maas AI et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):329-37.

Tasaki O, Shiozaki T, Hamasaki T, Kajino K, Nakae H, Tanaka H et al. Prognostic indicators and outcome prediction model for severe traumatic brain injury. J Trauma. 2009;66(2):304-8.