The FOUR Score and GCS as Predictors of Outcome After Traumatic Brain Injury

McNett, Molly; Amato, Shelly; Gianakis, Anastasia; Grimm, Dawn; Philippbar, Sue Ann; Belle, Josie; Moran, Cristina

doi:10.1007/s12028-013-9947-6

Cited by 51 publications

(48 citation statements)

References 31 publications

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“…In a study by McNett et al comprising 136 patients admitted to the ICU, the authors compared FOUR and GCS scores at 24 and 72 h for functional and cognitive outcomes, and also compared the scores at same time points with mortality [7]. The FOUR score was found comparable to GCS in terms of predictive ability for functional status, cognitive outcome at 3 months post-injury, and in-hospital mortality [7]. The AUCs for FOUR and GCS scores for predicting mortality were 0.913 and 0.935, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…In a recently published study by Mc Nett et al, the authors found that the FOUR score is comparable to GCS in terms of predictive ability for functional status, cognitive outcome at 3 months post-injury, and in-hospital mortality [7]. In a similar study by Sadaka et al, the authors found that FOUR score was an accurate predictor of in-hospital mortality, and neurologic outcome.…”

Section: Introductionmentioning

confidence: 94%

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Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury

et al. 2015

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“…Since its introduction in 2005, the FOUR score has been investigated against the GCS and it was found to have a similar if not higher prediction of mortality and poor neurological outcome in general ICU population,[7111718] traumatic brain injury patients,[19202122] stroke patients,[23] and patient admitted after cardiac arrest. [2425] Concerns have been reported regarding the accuracy of using the GCS,[2627] especially in intubated ICU patients due to the impracticality of assessing the verbal response.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study

Said

Chaari

Hakim

et al. 2016

Int J Crit Illn Inj Sci

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Objective:To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS).Patients and Methods:All intubated critically ill patients with a disturbed level of consciousness were assessed using both the FOUR score and the GCS. The FOUR score and the GCS were compared regarding their predictive value for successful extubation at 14 days after intubation as a primary outcome measure. The 28-day mortality and the neurological outcome at 3 months were used as secondary outcome measures.Results:Eighty-six patients were included in the study. Median age was 63 (50–77) years. Sex–ratio (M/F) was 1.46. On admission, median GCS was 7 (3–10) while median FOUR score was 8.5 (2.3–11). A GCS ≤ 7 predicted the extubation failure at 14 days after intubation with a sensitivity of 88.5% and specificity of 68.3%, whereas a FOUR score <10 predicted the same outcome with a sensitivity of 80.8% and a specificity of 81.7%. The areas under the curves was significantly higher with the FOUR score than with GCS (respectively 0.867 confidence interval [CI]: 95% [0790–0.944] and 0.832 CI: 95% [0.741–0.923]; P = 0.014). When calculated before extubation, FOUR score <12 predicted extubation failure with a sensitivity of 92.3% and a specificity of 85%, whereas a GCS <12 predicted the same outcome with a sensitivity of 73% and a specificity of 61.7%. Both scores had similar accuracy for predicting 28-day mortality and neurological outcome at 3 months.Conclusion:The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients.

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“…For the patients with TBI, the GCS scores for severe, moderate, and mild cases were 3–7, 8–12, and 13–15 points, respectively 37, 38 . Under the AIS-ISS, the patients with MPT were classified as mild (<16), moderate (16–25) or severe (>25) 39, 40 .…”

Section: Methodsmentioning

confidence: 99%

Dramatic increases in blood glutamate concentrations are closely related to traumatic brain injury-induced acute lung injury

Bai

Zhu

Ning

et al. 2017

Sci Rep

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Traumatic brain injury-induced acute lung injury (TBI-ALI) is a serious complication after brain injury for which predictive factors are lacking. In this study, we found significantly elevated blood glutamate concentrations in patients with TBI or multiple peripheral trauma (MPT), and patients with more severe injuries showed higher blood glutamate concentrations and longer durations of elevated levels. Although the increase in amplitude was similar between the two groups, the duration was longer in the patients with TBI. There were no significant differences in blood glutamate concentrations in the patients with MPT with regard to ALI status, but the blood glutamate levels were significantly higher in the patients with TBI-ALI than in those without ALI. Moreover, compared to patients without ALI, patients with TBI showed a clearly enhanced inflammatory response that was closely correlated with the blood glutamate levels. The blood glutamate concentration was also found to be a risk factor (adjusted odds ratio, 2.229; 95% CI, 1.082–2.634) and was a better predictor of TBI-ALI than the Glasgow Coma Scale (GCS) score. These results indicated that dramatically increased blood glutamate concentrations were closely related to the occurrence of TBI-ALI and could be used as a predictive marker for “at-risk” patients.

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The FOUR Score and GCS as Predictors of Outcome After Traumatic Brain Injury

Abstract: FOUR is comparable to GCS in terms of predictive ability for functional status, cognitive outcome 3 months post-injury, and in-hospital mortality.

Cited by 51 publications

References 31 publications

Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury

Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury

Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study

Dramatic increases in blood glutamate concentrations are closely related to traumatic brain injury-induced acute lung injury

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