We aimed to evaluate the predictors of clinical outcomes and OS following neurosurgical intervention among patients with severe TBI who presented with a GCS score of 3.

TBI registry data collected from two of the largest tertiary hospitals in Saudi Arabia was used in this study. The primary outcome measures were the Modified Rankin Scale (mRS) and OS in months. Patients were stratified into favorable (mRS = 0–2) and unfavorable (mRS = 3–6) outcome groups. A Cox proportional hazards model was created to identify potential predictors of survival.

Out of 2,443 patients with TBI, 150 met our inclusion criteria. The median age was 29 years, and 94% were males. The most common mechanism of injury was motor vehicle accident (MVA) 64%, and skull bone fracture was the most prevalent pathology 73.3%. The neurosurgical interventions were decompressive craniectomy 68%, hematoma evacuation 51.3%, and external ventricular drainage 24.7%. During a median follow-up time of two months, 26% of the patients died, with 84.6% of them not surviving beyond one month following neurosurgical intervention. Clinical outcomes were evaluated in 143 patients. The rate of unfavorable outcome was significantly higher in patients who aged 20-49 years (68.8%, p=0.01), had MVA (67%, p<0.001), and had one or both nonreactive pupils (p <0.001). Multivariable analysis revealed that the absence of reactivity in one pupil (HR: 10.1, 95% CI: 2.38–43.0, p=0.002) or both pupils (HR: 24.5, 95% CI: 7.30–82.0, p<0.001) was a significant predictor of reduced OS.