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

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.