Correlation of Glasgow Coma Scale with Non-Contrast Computed Tomography findings in immediate post traumatic brain injury

Basudev Agrawal, Rupesh Verma


Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.

Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.

Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).

Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.


GCS, NCCT findings, Traumatic brain injury

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Hryshko FG, Deeb ZL. Computed tomography in acute head injuries. J Computed Tomography. 1983;7(4):331-44.

Gentry LR. Imaging of closed head injury. Radio. 1994;191(1):1-7.

Kalsbeek WD, McLaurin RL, Miller JD. The national head and spinal cord injury survey: major findings. J Neurosurg. 1980:S19-31.

Ambrose J. Computerised transverse axial scanning (Tomography): clinical approach. Brit J Radio. 1974;46:679-95.

Hounsfield GN. Computerized transverse axial scanning (tomography): Part 1. Description of system. Bri J Radio. 1973;46(552):1016-22.

Sah SK, Subedi ND, Poudel K, Mallik M. Correlation of Computed Tomography findings with Glasgow Coma Scale in patients with acute traumatic brain injury. J Coll Med Sci Nepal. 2014;10(2):4-9.

Nitrini R. A Neurologia Todo Médico Deve Saber. Atheneu. Rio Janeiro-RJ. 1993.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;304(7872):81-4.

Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, et al. Influence of the type of intracranial lesion on outcome from severe head injury: a multicenter study using a new classification system. J Neurosurg. 1982;56(1):26-32.

Wardlaw JM, Easton VJ, Statham P. Which CT features help predict outcome after head injury? J Neurol Neurosurg Psychia. 2002;72:188-92.

Youmans J, eds. Neurological Surgery. 5th ed. Philadelphia: WB Saunders; 2004:5019-5273.

Teasdale GM. Sign guideline development group. Early management of patients with a head injury. Edinburgh: Scottish intercollegiate guidelines Network; 2000.

Marshall LF, Gautille T, Klauber MR. Eisenberg HM, Jane JA, Luerssen TG, et al. The outcome of severe closed head injury. J Neurosurg. 1991;75:S28-36.

Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurg. 1982;11:344-51.

Selladurai BM, Jayakumar R, Tan YY, Low HC. Outcome prediction in early management of severe head injury: an experience in Malaysia. Br J Neurosurg. 1992;6:549-7.

Marshall LF, Marshall SB, Klauber MR, van Berkum Clark M, Eisenberg HM, Jane JA et al. A new classification of head injury based on computerized tomography. J Neurosurg. 1991;75:S14-20.

Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurg. 2005;57(6):1173-82.

Raj R, Siironen J, B. Skrifvars M, Hernesniemi J, Kivisaari R. Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score). Neurosurg. 2014;75(6):632-47.

Kido DK, Cox C, Hamill RW, Rothenberg BM, Woolf PD. Traumatic brain injuries: predictive usefulness of CT. Radio. 1992;182(3):777-81.

Lobato RD, Cordobes F, Rivas JJ, de la Fuente M, Montero A, Barcena A, et al. Outcome from severe head injury related to the type of intracranial lesion: A computerized tomography study. J Neurosurg. 1983;59(5):762-74.

Yamaura A, Nakamura T, Ono J, Ariga N, Horie T, ShinoharA Y, et al. Prognostic value of CT in head injuries. Neurologia Medico Chirurgica. 1981;21(7):685-96.