COMPUTED TOMOGRAPHY FINDINGS AND THEIR CORRELATION WITH CLINICAL SEVERITY IN TRAUMATIC BRAIN INJURY: A MULTI-CENTRE STUDY FROM TERTIARY CARE HOSPITALS IN PAKISTAN

Abstract

Objective: To evaluate the spectrum of computed tomography (CT) findings in patients with traumatic brain injury (TBI) and to correlate these findings with clinical severity as assessed by the Glasgow Coma Scale (GCS). Study Design: Cross-sectional descriptive study. Place and Duration of Study: Departments of Neurosurgery and Radiology at three tertiary care hospitals in Pakistan, from 30th September 2025 to 30th March 2026. Methodology: A total of 102 patients presenting with traumatic brain injury were enrolled through non probability consecutive sampling. All patients underwent non-contrast CT of the brain within six hours of presentation. CT findings were classified according to the Marshall CT Classification. Clinical severity was graded using the GCS at admission. Correlation between CT findings and GCS severity categories (mild: 13 15, moderate: 9–12, severe: 3–8) was assessed using the chi-square test and Spearman rank correlation. Results: CT abnormalities were identified in 91 (89.2%) patients. Subdural haematoma was the most frequent finding (24; 23.5%), followed by cerebral contusion (21; 20.6%), subarachnoid haemorrhage (19; 18.6%), epidural haematoma (18; 17.6%), and diffuse axonal injury (9; 8.8%). A significant inverse correlation was observed between GCS score and Marshall CT grade (Spearman rho = -0.74; p<0.001). CT abnormality rates increased progressively with worsening GCS: 48.5% in mild, 79.3% in moderate, and 97.5% in severe TBI. In hospital mortality was 12.7% overall, rising to 27.5% in severe TBI. Conclusion: CT findings correlate significantly with clinical severity in TBI. Subdural haematoma and diffuse axonal injury are associated with the most severe clinical presentations and highest mortality. Non-contrast CT within six hours of injury remains an indispensable diagnostic tool in the management of TBI at tertiary care centres in Pakistan.