Factors Associated With Poor One-Month Glasgow Outcome Scale Scores After Traumatic Brain Injury With Intracranial Hemorrhage in Adult Patients Presenting to the Emergency Department

Abstract

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