Integrated optic nerve sheath diameter, glasgow coma scale and computed tomography based model for early prediction of clinically significant brain injury in head trauma: A prospective observational study.

Acute head injury requires rapid identification of clinically significant brain injury (CSBI), yet access to CT imaging is often limited, creating challenges in early triage. In this prospective study of 215 head trauma patients, optic nerve sheath diameter (ONSD) and Glasgow Coma Scale (GCS) were evaluated as predictors of CSBI. Patients with CSBI had significantly higher ONSD and lower GCS and both variables independently predicted injury severity. The combined ONSD + GCS model demonstrated better diagnostic performance, clinical utility and calibration than either parameter alone, with ONSD showing a dose-response relationship with CT severity. Thus, data shows the validating a practical bedside risk stratification approach that integrates ultrasound-derived ONSD with GCS to improve CSBI prediction, particularly in resource-limited settings.