Significance of Best Motor Response in Evaluating the Outcome of Severe Traumatic Brain Injury Patients

Abstract

Objective: To determine the significance of best motor response (BMR) in evaluation the outcome of severe traumatic brain injury patients at a tertiary care Hospital.

Methodology: A prospective observational study was done at Department Neurosurgery, Pakistan Institute of Medical Sciences (PIMS) Islamabad, from June 2023 to May 2024. Patients aged 18 to 60 years old, both gender presented with diagnosis of sever Severe traumatic brain injuries; evaluated by Glasgow Coma Scale “GCS” score of 3 to 8 at the time of admissions were included. All the patients underwent treatment involved comprehensive approaches include surgical interventions, monitoring of the intracranial pressure (ICP), and the conservative (medical treatment). BMR score was categorized into six domains. Final recovery was assessed by employing the GOS, which was further categorized in five classes.

Results: Overall mean age of the patients was 27.55 years and Mean Glasgow Coma Scale (GCS) score at admission was 9.38. Based on BMR 3.8% cases showed no response, 11.5% had Decerebrate posture, 7.7% had decorticated posture, 19.2% exhibited flexion to pain, 42.3% localized pain, and 15.4% obeyed all commands. There was a significant between BMR scores and overall recovery (GOS score) (p - 0.001). Cases with high BMR scores (42.3% with localizing pain and 15.4% with obeying commands) showed better recovery (GOS score V), while those with lower BMR scores (e.g., 3.8% with no response and 11.5% with decerebrate posture) had poorer outcomes (GOS scores I and II). These results show that higher BMR scores are linked to better recovery, while lower scores are associated with worse outcomes.

Conclusion: BMR observed to be a reliable and early indicator of prognosis among patients with STBI, which may guide clinical decision-making and management. Higher BMR scores, especially for pain localization and obeying commands, were linked to better recovery outcomes, while lower scores were associated with poor outcomes.