Comparison of Prognostic Scales in Management of Mild Cases of Traumatic Brain Injury (Gcs-15-13)

Abstract

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality, and reliable bedside prognostic tools remain essential for early risk stratification, particularly in resource-limited settings. This study compared the predictive performance of four prognostic scales - the Madras Head Injury Prognostic Scale (MHIPS), the Edinburgh Prognostic Model, the National Institute of Mental Health and Neurosciences (NIMHANS) Prediction Score, and the Injury Severity Score (ISS) - in patients presenting with traumatic brain injury. Methods: This prospective observational study was conducted in the Department of General Surgery of a tertiary care teaching hospital in Gujarat, India, over a period of one and a half years, and enrolled 50 patients presenting with traumatic brain injury and a Glasgow Coma Scale (GCS) score of 13-15 at admission. Clinical, radiological and systemic parameters were recorded, and the four prognostic scales were calculated for each patient. Sensitivity, specificity and the association between prognostic score category and clinical outcome (discharge versus death) were analyzed. Results: The mean age of patients was 39.6 ± 11.9 years, with a male predominance (58%). Mean scores were MHIPS 17.42 ± 15.6, Edinburgh Prognostic Model 4.14 ± 1.29, NIMHANS Prediction Score 1.88 ± 0.8, and ISS 37.36 ± 21.75. Mortality was significantly higher among patients scoring below 50 points on the combined prognostic assessment (9/27, 33.3%) compared with those scoring above 50 points (2/23, 8.7%; p=0.036). The NIMHANS Prediction Score showed the highest sensitivity (87.4%), while the Edinburgh Prognostic Model showed the highest specificity (92.3%). Overall, 39 patients (78%) were discharged and 11 (22%) died. Conclusions: The NIMHANS Prediction Score and the Edinburgh Prognostic Model showed the best sensitivity and specificity, respectively, among the scales evaluated. Bedside prognostic scoring remains a valuable, low-cost method for early outcome prediction in traumatic brain injury, and future research should explore integration of these scales with emerging biomarker- and imaging-based prognostic tools.