ArticleClinics (Sao Paulo, Brazil)2026
Glasgow coma scale-pupils at 24-hours as a reliable marker for extremely poor prognosis in traumatic brain injury - A prospective cohort.
Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveEarly prognosis determination after traumatic brain injury remains challenging, yet reliable early markers remain limited. A Glasgow Coma Scale-Pupil (GCS-P) score of 1, combining a GCS of 3 and bilaterally nonreactive pupils, has been proposed as a marker of catastrophic injury, although some patients may recover. The authors hypothesized that persistence of a GCS-P score of 1 after 24 h could predict poor prognosis.
methodsDescriptive study in a quaternary ICU in Brazil, including adult patients admitted between 2019 and 2025 with a pre-sedation GCS of 3 and bilaterally nonreactive pupils. Patients with unknown initial neurological status or a Marshall Computed Tomography Classification < 3 were excluded. Clinical characteristics, imaging findings, treatments, and outcomes were prospectively collected. The primary outcome was the Glasgow Outcome Scale-Extended (GOSE) at hospital discharge.
resultsAmong 2645 ICU admissions, 868 were due to TBI, and 49 met the inclusion criteria. Patients were predominantly young (median age 38-years), male (79.6%), and had high illness severity (median SAPS3 of 68). Most suffered blunt trauma, and nearly half underwent hemicraniectomy. All patients who persisted with a GCS-P score of 1 after 24-hours died during hospitalization (n = 36, 95% CI 90.3%-100%). Among those who improved their GCS-P score within 24-hours (n = 13), mortality was 54% (95% CI 25.1%-80.8%), and 31% (95% CI 9.1%-61.4%) recovered consciousness (GOSE > 2).
conclusionPersistence of a GCS-P score of 1 after 24-hours is a highly reliable marker of poor prognosis in patients with severe TBI. These findings warrant external validation.
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