FOUR has the Best Predictive Validity for Patients with Severe Consciousness Disorders or Mechanical Ventilation

Abstract

Background: To investigate the predictive validity of GCS, GCS-Pupils and FOUR for patients admitted to the Neuro-Surgical ICU. Methods: In this retrospective study, all the adult patients admitted to Neuro-Surgical ICU from January 2017 to January 2020 were recruited. The GCS, GCS-pupils and FOUR scores were obtained at their ICU admission. Correlation analyses were conducted between the scores and the outcomes. Results: 181 patients were included in the outcomes analysis. The average scores of GCS was 5 (3-9), GCS-Pupils was 5 (1-10) and FOUR was 7 (0-16).The scores of all the three scales were correlated with the primary outcome (6-month GOSE), FOUR had the best predictive value(OR=0.5, 95%CI: 0.4~0.5) and the most refined cut-off value.The scores of the FOUR and GCS-Pupils were correlated with all the secondary outcomes(p<0.05), the scores of GCS was not correlated with the ICU LOS and MV time(p>0.05). In the subgroup analysis of more severe patients, the scores of FOUR were correlated with all the outcomes(p<0.01) except the ICU LOS and MV time(p>0.05), the scores of the GCS-Pupils were not correlated with the outcomes(p>0.05). Conclusions: FOUR has the best predictive validity for patients admitted to NSICU, especially for those with severe consciousness disorders or mechanical ventilation.