Predictors of outcome in patients with traumatic brain injury undergoing neurosurgical intervention

Abstract

ABSTRACT

Background:Traumatic brain injury (TBI) is a major cause of mortality and neurological disability, particularly among patients requiring neurosurgical intervention. Early identification of factors associated with poor outcome can assist in prognostication, perioperative management, and counseling of patients and their relatives. This study evaluated clinical, radiological, and treatment-related predictors of outcome in patients with TBI undergoing neurosurgical intervention.Methods:A prospective observational study was conducted in 250 patients aged ≥18 years with traumatic brain injury who underwent neurosurgical intervention. Demographic characteristics, mechanism of injury, admission Glasgow Coma Scale (GCS), pupillary response, computed tomography (CT) findings, type and timing of surgery, and postoperative complications were recorded. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) at the predefined follow-up. GOS scores 4–5 were considered favorable and scores 1–3 unfavorable. Predictors of outcome were evaluated using univariate analysis followed by multivariable logistic regression.Results:The mean age was 41.8 ± 17.6 years, and 78.4% of patients were male. Road traffic accidents were the commonest mechanism of injury (56.8%). Acute subdural hematoma was the most frequent CT finding (35.6%). Overall, 153 (61.2%) patients had a favorable outcome, whereas 97 (38.8%) had an unfavorable outcome. Mortality was 16.8%. Low admission GCS (≤8), bilateral non-reactive pupils, age >60 years, midline shift >5 mm, compressed/absent basal cisterns, and postoperative complications were significantly associated with unfavorable outcome. On multivariable analysis, admission GCS ≤8 was the strongest independent predictor (adjusted OR 4.86; 95% CI 2.58–9.15; p<0.001).Conclusion:Outcome following neurosurgical intervention for TBI is influenced by multiple clinical and radiological factors. Admission GCS, pupillary response, age, CT findings, and postoperative complications are important predictors of unfavorable outcome. Early identification of high-risk patients may facilitate timely intervention and optimized postoperative care.