Abstract
<title>Abstract</title> <p>Background Computed tomography (CT) is central to acute traumatic brain injury (TBI) assessment but is often limited to diagnostic rather than prognostic use. High-volume emergency settings require early, objective imaging markers to support disposition decisions. Methods We conducted a retrospective cohort study of 11,767 TBI patients who underwent early CT at index presentation. Demographics, injury mechanisms, CT findings, and outcomes were analyzed. The primary outcome was admission or treatment. Chi-square tests, logistic regression, interaction analyses for sex-age and sex–skull fracture, and ROC analysis were performed. Results Among the 11,767 patients, 2,219 (18.9%) required admission or treatment, while 9,548 (81.1%) were discharged without intervention. Patients who required admission presented a greater burden of CT abnormalities, including skull fractures, mass effects, and intracranial injury. According to the multivariate analysis, midline shift was the strongest predictor (aOR 12.43), followed by cerebral contusion (10.94), cerebral edema (8.91), and pneumocephalus (6.44). Skull fracture remained independently associated with admission in males (OR 2.81) and females (OR 4.61), with a significant sex interaction. The predicted probability increased from 18.8% to 37.4% in males and 15.6% to 42.5% in females. The age‒by‒sex interaction was not significant. Model discrimination was modest (AUC 0.6902). Conclusions Early CT findings were strongly associated with short-term clinical outcomes in TBI patients. Midline shift, cerebral contusion, cerebral edema, pneumocephalus, and skull fracture were key predictors of admission or treatment. The sex-specific effect of skull fracture suggests improved risk stratification and supports the integration of CT-based parameters into structured triage systems for acute TBI care.</p>