18-Month Functional Outcomes of Surgically and Conservatively Managed Moderate and Severe Traumatic Brain Injury: A Single-Centre Retrospective Cohort Study

Traumatic brain injury (TBI) remains a major cause of death and disability. Comparative outcome data for surgically and conservatively managed moderate and severe TBI remain limited in low- and middle-income settings. The aim of the study is to compare 18-month functional outcomes among hospital survivors of moderate and severe TBI managed surgically or conservatively. This retrospective cohort included 527 adults with isolated moderate (Glasgow Coma Scale [GCS] 9–12) or severe TBI (GCS 3–8) admitted from July 2022 to June 2023. The Glasgow Outcome Scale–Extended (GOS-E) was assessed at 6, 12, and 18 months; GOS-E 7–8 was considered favorable and death was assigned a GOS-E score of 1. Inverse probability of treatment weighting (IPTW) was used to address measured confounding, and repeated outcomes were analyzed using generalized estimating equations. The cohort included 340 patients with moderate and 187 with severe TBI patients; 239 (45.4%) underwent surgery. At 18 months, a favorable outcome occurred in 103/135 (76.3%) surgical versus 149/205 (72.7%) conservative patients with moderate TBI, and in 45/104 (43.3%) versus 16/83 (19.3%) patients with severe TBI, respectively. After IPTW, surgery was not significantly associated with favorable outcome in moderate TBI (OR 1.29, 95% CI 0.79–2.09; p = 0.304) but remained associated with favorable outcomes in severe TBI (OR 2.37, 95% CI 1.20–4.66; p = 0.013). The treatment-by-severity interaction was not significant (p = 0.151). Among hospital survivors, recovery continued through 18 months. Surgery remained associated with favorable outcome in severe, but not moderate, TBI after adjustment. Because treatment was clinically selected and in-hospital deaths were excluded, these findings should not be interpreted as causal.