Assessment of Glasgow Coma Scale (GCS) as Predictor of Mortality in Patients with    Severe Head Injury

Atta-Ur-Rehman Khan; Aushtar Abbas  Naqvi; Sarwat  Rasheed; Safdar  Manzoor; Malik  Fahad

doi:10.51253/pafmj.v76iSUPPL-9.14366

Authors

Atta-Ur-Rehman Khan Department of Neurosurgery, Dera Ghazi Khan Medical College, Dera Ghazi Khan Pakistan
Aushtar Abbas Naqvi Department of Neurosurgery, Dera Ghazi Khan Medical College, Dera Ghazi Khan Pakistan
Sarwat Rasheed Department of Neurosurgery, Dera Ghazi Khan Medical College, Dera Ghazi Khan Pakistan
Safdar Manzoor Department of Neurosurgery, Dera Ghazi Khan Medical College, Dera Ghazi Khan Pakistan
Malik Fahad Department of Neurosurgery, Dera Ghazi Khan Medical College, Dera Ghazi Khan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-9.14366

Keywords:

Glasgow Coma Scale, Head Injury, Mortality, Prognosis, Traumatic Brain Injury, Triage

Abstract

Objective: To assess the predictive accuracy of the admission Glasgow Coma Scale (GCS) for 30-day in-hospital mortality with patients of severe head injury.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Neurosurgery Department, Allama Iqbal Teaching Hospital, DG Khan, Pakistan, from Aug 2025 to Feb 2026.

Methodology: A total of 196 adult patients with severe head injury (GCS ≤8) confirmed by CT scan were enrolled using non-probability consecutive sampling. Data on demographics, clinical parameters, CT reports, and interventions were collected. The primary result was 30 day in-hospital mortality. to recognize independent predictors of mortality, Univariate and multivariate logistic regression analyses were performed for data analysis.

Results: The 30-day mortality rate was 68 (34.7%). Non-survivors had significantly lower admission GCS (5.2±1.4 vs. 6.9±1.2, p<0.001), high rates of pupillary non-reactivity (73.5% vs. 25.8%, p<0.001), and greater occurrence of midline shift ≥5 mm (77.9% vs. 44.5%, p<0.001). Multivariate analysis identified GCS ≤5 (aOR=4.8, p<0.001), pupillary non-reactivity (aOR=5.2, p<0.001), midline shift ≥5 mm (aOR=3.1, p<0.001) and age >60 years (aOR=2.9, p=0.002) as independent forecasters of mortality.

Conclusion: Admission GCS, particularly a score ≤5, along with pupillary response and CT findings are strong independent predictors of mortality in severe head injury, supporting their use in early risk stratification.

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