External validation of the GCS-Pupils Score as an outcome predictor after traumatic brain injury in adults: a single-center experience

Objective The GCS-Pupils (GCS-P) score is a recently described scoring system to aid outcome prediction in patients with traumatic brain injury (TBI). The aim of this study was to provide the first external validation of the GCS-P score by identifying independent predictors of outcome in TBI patients. Methods Review of prospective adult (≥ 16 years) TBI database at a tertiary neurosurgical center with a catchment population of 1.5 million over a 12-month period commencing October 2016. Multivariate logistic regression was used to identify predictors of discharge destination and 30-day mortality. Results Three hundred and fifty-eight patients were included. The median age was 60 years with a male predominance of 64%. The median GCS-P was 14 (interquartile range 12–15) and the commonest GCS-P category was mild (13–15; 238/358, 66%). Discharge destination was home in 69% of patients and rehab services or equivalent in 31%. Multivariate analysis identified age ( p = 0.01), CT findings of an acute subdural hematoma ( p = 0.01) or diffuse axonal injury ( p = 0.02), and a neurosurgical operation ( p = 0.02) as independent predictors of discharge destination. The 30-day mortality rate was 11%. Within the category of severe TBI (GCS-P ≤ 8), GCS-P was able to identify patients with a very high likelihood of 30-day mortality (GCS-P ≤ 4; 16/31, 52%). Multivariate analysis revealed the Charlson comorbidity score ( p = 0.01), GCS-P ( p = 0.02), and traumatic subarachnoid hemorrhage ( p = 0.05) as independent predictors of mortality. Conclusion The GCS-P is a useful predictor of 30-day mortality, although its usefulness for other clinical outcomes remains to be proven.