Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit

Abstract

BackgroundTraumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis.ObjectivesThis study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit.Patients and MethodsThis diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics.ResultsThe results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively.ConclusionsConsidering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality.

The Relationship of the FOUR Score to Patient Outcome: A Systematic Review

“…The number of patients reported by each included study ranged from 35 16 to 1645. 15 For the purposes of this review, reports by Gorji and colleagues 16,25 and Hosseini and colleagues 26 of a single population of 80 patients were considered to be a single study. Likewise, reports of a single cohort by McNett and colleagues in 2016 27 and 2014 17 were considered to be a single study.…”

“…Of these studies, 25 described in-hospital mortality 7,14,23,24,29,33,35,36,38–41,15,42,45–47,49,16–22 as the end point, 5 investigated mortality only up to 2 weeks post-event, 25,26,28,37,38 and 11 studies explored longer-term mortality up to 3–6 months. 14,25,52,26,30–32,34,42,44,45 The mortality rate between included studies varied widely—from 7.8% 36 to 70% 28 —among studies where FOUR score was assessed within 24 h of admission. Studies using later time points of FOUR score assessment reported mortality within the above range (Supplementary Table S3).…”

Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury

“…41 GCS is also a strong predictor of in-hospital mortality and poor neurological outcome. 32,42 We assessed functional outcome at discharge from the in-patient neuroscience stepdown unit while the aforementioned studies assessed functional outcome between 14-days to 6 months post-injury. While the association between injury severity and outcome in patients with moderate and severe TBI is well known, what we can conclude about initial injury severity and functional outcome in this sample is this: GCS could be a signal for subsequent functional outcome, but cannot supplant other important clinical factors.…”

Significance of Cardiac Troponin I Elevation in Traumatic Brain Injury Patients

“…Traumatic brain injury (TBI) as a major health and socioeconomic concern, remains one of the main causes of mortality and morbidity among the cases with trauma worldwidethroughout the world (1-4). The incidence of TBI is rising especially in the developing countries with a significant financial annual burden due to more vehicle use.…”