Beyond survival: Early global functional outcome and its determinants in traumatic brain injury at a district-level teaching hospital in Pakistan

Objectives: To prospectively assess the outcomes of traumatic brain injury (TBI) patients at discharge and identify independent factors associated with unfavorable outcomes at a district level hospital in Pakistan. Methodology: We conducted a prospective observational cohort study of all patients who presented with TBI at Aziz Bhatti Shaheed Teaching Hospital Gujrat, Pakistan between August 2025 and January 2026. Global Functional outcomes on Glasgow Outcome Scale Extended (GOS-E) scale at discharge were recorded against variables including demographic, clinical, radiological, management, and hospital course data. Outcomes were grouped into favorable (GOS-E 5-8) and unfavorable (GOS-E 1-4). IBM SPSS Statistics 27 was used for data analysis including univariate and regression models to determine independent predictors of unfavorable outcomes. Results: Out of the 363 TBI patients, 299 (82.4%) had a favorable outcome and 64 (17.6%) had an unfavorable outcome at discharge. Presenting Glasgow Coma Scale (GCS) (p<0.001), age (p<0.001), rural demographic (p=0.04), chest injury (p<0.001), limb injury (p=0.008), and other extracranial injuries (p<0.001) were significantly associated with unfavorable outcomes on univariate analysis. Among these, presenting GCS (moderate vs mild OR 6.972 and severe vs mild OR 192.54), age (OR 1.04), and other extracranial injuries (OR 76.801) were independently associated with unfavorable outcomes after logistic regression. Conclusion: Presenting GCS, age, and associated extracranial injuries (spinal, chest, abdominal and pelvic) are significantly associated with outcome at discharge after TBI. GCS based early risk assessment alongside timely identification of associated injuries in polytrauma patients can help identify patients at risk of poor early outcome and guide management and referral decisions, especially in resource-limited settings.