Objective: To assess the outcome of severe head injury in patients with GCS 8 or below. Design:Retrospective study. Setting: Department of Neurosurgery, Allied Hospital, Punjab Medical College, Faisalabad.Period: Two years Aug 2002 to July 2004. Material and Methods: Two hundred patients admitted in the departmentof Neurosurgery, Allied Hospital, with Glasgow Coma scale 8 or below irrespective of mode of injury and age wereselected with a follow up of up to twelve months. The patients were assessed on arrival in the emergency room on thebasis of GCS. The patients were managed accordingly. Results: 71% patients were managed conservatively and 29%patients under went surgical intervention. Overall mortality was 40%. Outcome was good in 15% where as 11% patientsremained vegetative. Conclusion: Severe head injury has a mortality of 40%, especially in very young and very oldpatients.