Revisiting the Classification of Moderate and Mild Traumatic Brain Injury Based on the Admission Glasgow Coma Scale Score

Abstract Objective  We study the clinical relevance of classifying traumatic brain injury (TBI) into moderate and mild categories based on the Glasgow Coma Scale (GCS) score at admission with respect to the treatment intensity and 6-month mortality and morbidity rates. Methods  Analysis of patients from a prospectively maintained database admitted at a level I trauma center from 2013 to 2019 with an admission GCS score between 9 and 15 and a minimum follow-up of 6 months post-TBI was done to study the treatment intensity and 6-month morbidity and mortality rates for each GCS score from 9 to 15. Results  In all, 2,060 patients met the study criteria, of which 1,684 were males (81.7%). Road traffic accident was the most common cause of TBI (83.7%). There was a significant linear increase in the proportion of patients who had good outcomes with increasing GCS scores from 9 to 15 ( p ≤ 0.001). When the variables in each GCS score were compared with a GCS score of 15, there was an increase in the odds ratio of mortality and poor outcome with decreasing GCS scores ( p ≤ 0.001). Patients with a lower admission GCS score required more intense treatment in the form of surgery and ventilation ( p ≤ 0.00001). There was a higher incidence of pupillary asymmetry in patients with lower GCS scores ( p ≤ 0.00001). Conclusions  The classification of TBI patients into moderate and mild based on the GCS score at admission is not of any practical value, and TBI patients may be more usefully classified based on the admission GCS score into severe and not severe groups.