Abstract
Background: The Glasgow Coma Scale (GCS) is a cornerstone in neurological assessment, providing critical insights into consciousness levels in patients with traumatic brain injuries and other neurological conditions. Despite its clinical importance, traditional methods for predicting GCS scores often fail to capture the complex, multi-dimensional nature of patient data. This study aims to address this gap by leveraging machine learning (ML) techniques to develop accurate, interpretable models for GCS prediction, enhancing decision making in critical care. Methods: A comprehensive dataset of 759 patients, encompassing 25 features spanning pre-, intra-, and post-operative stages, was used to develop predictive models. The dataset included key variables such as cognitive impairments, Hunt and Hess scores, and aneurysm dimensions. Six ML algorithms, including random forest (RF), XGBoost, and artificial neural networks (ANN), were trained and rigorously evaluated. Data preprocessing involved numerical encoding, standardization, and stratified splitting into training and validation subsets. Model performance was assessed using accuracy and receiver operating characteristic area under the curve (ROC AUC) metrics. Results: The RF model achieved the highest accuracy (86.4%) and mean ROC AUC (0.9592 ± 0.0386, standard deviation), highlighting its robustness and reliability in handling heterogeneous clinical datasets. XGBoost and SVM models also demonstrated strong performance (ROC AUC = 0.9502 and 0.9462, respectively). Key predictors identified included the Hunt and Hess score, aneurysm dimensions, and post-operative factors such as prolonged intubation. Ensemble methods outperformed simpler models, such as K-nearest neighbors (KNN), which struggled with high-dimensional data. Conclusions: This study demonstrates the transformative potential of ML in GCS prediction, offering accurate and interpretable tools that go beyond traditional methods. By integrating advanced algorithms with clinically relevant features, this work provides a dynamic, data-driven framework for critical care decision making. The findings lay the groundwork for future advancements, including multi-modal data integration and broader validation, positioning ML as a vital tool in personalized neurological care.