Correlation of Glasgow Coma Scale and Pupillary Response with Computed Tomography Findings in Moderate and Severe Head Injury: A Cross-Sectional Observational Study

Abstract

Background: Traumatic brain injury (TBI) remains a major cause of mortality and disability worldwide. Early identification of intracranial abnormalities is crucial for prompt intervention. Glasgow Coma Scale (GCS) and pupillary reactivity are simple bedside neurological assessment tools that may predict intracranial pathology. Aim: To evaluate the correlation between Glasgow Coma Scale scores, pupillary response, and computed tomography (CT) brain findings in patients with moderate and severe head injury. Methods: A cross-sectional observational study was conducted at Government General Hospital, over 18 months from March 2023 to August 2024. One hundred adult patients with moderate or severe head injury (GCS ≤12) were enrolled. GCS score and pupillary response were recorded at admission and serially assessed. CT brain imaging was performed in all patients. Statistical analysis was performed using Chi-square test to determine associations between clinical parameters and CT findings. Results: Among 100 patients, 67% were males and 33% were females. The mean age was 45.36 ± 16.76 years. Road traffic accidents were the commonest mechanism of injury (57%). Moderate head injury (GCS 9–12) was observed in 83% of patients, while 17% had severe head injury (GCS 3–8). CT abnormalities were identified in 85% of cases. Subarachnoid hemorrhage was the most common finding (33%), followed by subdural hematoma (25%) and extradural hematoma (13%). All patients with severe head injury demonstrated intracranial abnormalities on CT compared with 81.9% of moderate head injury patients (p=0.038). Similarly, all patients with fixed pupils demonstrated intracranial pathology on CT compared with 79.5% of patients with reactive pupils (p=0.01). Conclusion: Lower GCS scores and abnormal pupillary responses are significantly associated with intracranial abnormalities detected on CT imaging. Combined assessment of GCS and pupillary reactivity serves as an effective bedside tool for identifying patients requiring urgent neuroimaging and neurosurgical evaluation.

Keywords: Traumatic brain injury, Glasgow Coma Scale, Pupillary response, Computed tomography, Head injury, Intracranial hemorrhage.