Outcomes of Surgical Versus Conservative Management in Severe Traumatic Brain Injury (GCS 3-4) With…

Cohort studyKorean journal of neurotrauma· Jul 2026

Outcomes of Surgical Versus Conservative Management in Severe Traumatic Brain Injury (GCS 3-4) With Evacuable Mass Lesions: A Retrospective Cohort Study.

Hanuman Prasad Prajapati, B K Ojha, Jason Golmei

NeurotraumaCohort studyTreatmentQ2IF 1.4

Surgery for severe traumatic brain injury with mass lesions linked to higher odds of favorable outcome

Outcomes of Surgical Versus Conservative Management in Severe Traumatic Brain Injury (GCS 3-4) With Evacuable Mass Lesions: A Retrospective Cohort Study.

Hanuman Prasad Prajapati … Jason Golmei

Korean journal of neurotrauma · Jul 2026

Background

Management of patients with severe traumatic brain injury (traumatic brain injury) presenting with Glasgow Coma Scale (Glasgow Coma Scale) scores of 3-4 and surgically evacuable intracranial hematomas remains controversial because of perceived futility and poor outcomes.

Purpose

This study compared outcomes of surgical versus conservative management in this patient population.

Methods

This retrospective observational study included patients with traumatic brain injury (Glasgow Coma Scale 3-4) and surgically evacuable intracranial mass lesions admitted to a tertiary care centre between December 2015 and December 2023.

n = 752 patients

Results

surgery nearly quadrupled the odds of a favorable recovery

OR 3.70 (95% CI 2 to 6.80)

null 1

2

6.80

CI excludes the null - significant

More results

Surgery was associated with shorter intensive care unit stay ( p =0.001) and fewer systemic complications ( p =0.003).

Favourable outcomes were significantly more frequent following surgery in patients aged <40 years, with extradural hematoma, unilateral or bilateral pupillary dilation, and intervention within 6 hours of injury (all p <0.05).

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Conclusion

Despite an overall poor prognosis, surgical evacuation of mass lesions in traumatic brain injury patients with Glasgow Coma Scale 3-4 was associated with improved survival and functional outcomes in selected patients, although causality cannot be inferred.

Outcomes of Surgical Versus Conservative Management in Severe Traumatic Brain Injury (GCS 3-4) With Evacuable Mass Lesions: A Retrospective Cohort Study.

Outcomes of Surgical Versus Conservative Management in Severe Traumatic Brain Injury (GCS 3-4) With Evacuable Mass Lesions: A Retrospective Cohort Study.

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