Glasgow Coma Scale Score at Admission in Traumatic Brain Injury Patients: A Multicenter Observational Analysis

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal-Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = -0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings.

Keywords: Eastern Europe; Glasgow Coma Scale; clinical outcome; hospital outcomes; prognostic factors; retrospective study; socio-demographic outcome; socioeconomic factors; traumatic brain injury.

Figure 1

Descriptive statistics—Mean and median for GCS total admission score, length of stay, and age for the included TBI patients (n = 119).

Figure 2

Descriptive statistics—Mean and median for inpatient hospitalization (days) for GCS total admission score (used as a categorical variable; severe (GCS ≤ 8), moderate (GCS 9–12), and mild (GCS 13–15)).

Figure 3

Descriptive statistics—Mean and median for age, stratified by GCS total admission score (used as a categorical variable: severe (GCS ≤ 8), moderate (GCS 9–12), and mild (GCS 13–15)).