Comparison of outcome predictions by the Glasgow coma scale and the Full Outline of UnResponsiveness score in the neurological and neurosurgical patients in the Intensive Care Unit

Abstract

Assessment of level of consciousness is very important in predicting patient's outcome from neurological illness. Glasgow coma scale (GCS) is the most commonly used scale, and Full Outline of UnResponsiveness (FOUR) score is also recently validated as an alternative to GCS in the evaluation of the level of consciousness. We carried out a prospective study in 97 patients aged above 16 years. We measured GCS and FOUR score within 24 h of Intensive Care Unit admission. The mean GCS and the FOUR scores were lower among nonsurvivors than among the survivors and were statistically significant (P < 0.001). Discrimination for GCS and FOUR score was fair with the area under the receiver operating characteristic curve of 0.79 and 0.82, respectively. The cutoff point with best Youden index for GCS and FOUR score was 6.5 each. Below the cutoff point, mortality was higher in both models (P < 0.001). The Hosmer-Lemeshow Chi-square coefficient test showed better calibration with FOUR score than GCS. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.91 (P < 0.001).

A comparison between the effectiveness of full outline of unresponsiveness and glasgow coma score at neurosurgical intensive care unit patients

“…In this study, where GCS and FOUR scores have been compared in brain tumor or head trauma patients at the intensive care unit, we found that the FOUR score is as effective and trustworthy as GCS. Other reports also reveal the same thing as our study (1,4,(7)(8)(9)13).…”

“…However, there is no objective value such as body temperature or blood pressure to evaluate intensive care unit comatose patients, and therefore different scales are used (10). One of these scales is Glasgow Coma Score (GCS), which is known worldwide and commonly used to predict the level of, consciousness, mortality and morbidity (4,9,10,13). Even Different scoring systems have therefore been developed to evaluate patients in time (3,9).…”

“…One of these scales is Glasgow Coma Score (GCS), which is known worldwide and commonly used to predict the level of, consciousness, mortality and morbidity (4,9,10,13). Even Different scoring systems have therefore been developed to evaluate patients in time (3,9). One of these scores is the Full Outline of Unresponsiveness (FOUR) Score that was developed by Wijdicks et al in 2005 (3,4,9,13,16).…”

“…There are 4 headers (eye response, motor response, brainstem reflexes, respiration) and scores from 0 to 4, to evaluate patients with FOUR which was recommended by the European Society of Intensive Care Medicine (ESICM) (3,4,9,13). Therefore using the FOUR score ensures that brainstem reflexes, respiration pattern and verbal response that are supplementary data for patient evaluation, absent in GCS, can be used (3,4,9). The FOUR score has advantages and still investigated by different countries and clinics (10).…”

“…The FOUR score has advantages and still investigated by different countries and clinics (10). In some studies, there was no sample calculation for comparing GCS and FOUR, no surveys for GCS and FOUR at the same time, studies reported just for the first 24 hours and only traumatic brain injury patients or intubated patients had been included (1,4,9,10,14). There is no survey that includes all cases such as brain tumor patients or head trauma patients and lasts longer than one day.…”