Value of Nonspecific Severity Scores in Predicting Mortality in Severe Traumatic Brain Injury

Abstract

Introduction: Severe traumatic brain injury (sTBI) is a leading cause of mortality in young adults. Neurological scores alone, such as the Glasgow Coma Scale (GCS), may be insufficient due to associated organ dysfunction. This study evaluated the predictive value of nonspecific severity scores (APACHE II, SAPS II) and organ dysfunction scores (SOFA, LODS, and MODS) for mortality in ICU patients with sTBI. Methods: Prospective descriptive and analytical study over 10 months in a 22-bed multidisciplinary ICU at Habib Bourguiba University Hospital, Sfax. Adult patients (≥18 years) with sTBI (GCS ≤ 8) admitted for ≥24 hours were included. Data collected included demographics, neurological and biological status, imaging, interventions, initial severity scores, and organ dysfunction scores on days 1, 3, and 5. Univariate and multivariate analyses were performed to identify factors associated with mortality. Predictive performance was assessed using ROC curves (AUC, sensitivity, specificity). Results: Thirty-seven patients were included, with a median age of 40 years and 86% male. Road traffic accidents accounted for 86%. ICU mortality was 16.2%. Non-survivors had higher SAPS II and APACHE II scores (p < 0.01). LODS and MODS scores on days 1, 3, and 5 were significantly associated with mortality. ROC analyses showed excellent discrimination, particularly for LODS on day 5 (AUC 0.911). Multivariate analysis revealed MODS day 1, LODS day 3, and LODS day 5 as autonomous predictors of mortality. Conclusion: Nonspecific severity scores and serial organ dysfunction scores are reliable tools for predicting ICU mortality in sTBI. Dynamic assessment enhances prognostic accuracy and may guide clinical decision-making.