Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury

Authors

  • Fahad Ansari Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Arvind Rai Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20214759

Keywords:

FOUR scale, Glasgow coma scale, Traumatic head injury, Unresponsiveness

Abstract

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.

Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.

Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.

Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients. 

References

Hosseini SH, Ayyasi M, Akbari H, Gorji MAH. 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. Anesth Pain Med. 2017;7(5):33653.

Raj R, Siironen J, Kivisaari R, Hernesniemi J, Skrifvars MB. Predicting outcome after traumatic brain injury: Development of prognostic scores based on the IMPACT and the APACHE II. J Neurotrauma. 2014;31(20):1721-32.

Bruno MA, Ledoux D, Lambermont B, Damas F, Schnakers C, Vanhaudenhuyse A, et al. Comparison of the full outline of unresponsiveness and Glasgow liege scale/Glasgow coma scale in an intensive care unit population. Neurocrit Care. 2011;15(3):447-53.

Eken C, Kartal M, Bacanli A, Eray O. Comparison of the full outline of unresponsiveness score coma scale and the Glasgow coma scale in an emergency setting population. Eur J Emerg Med. 2009;16(1):29-36.

Gorji MA, Hoseini SH, Gholipur A, Mohammadpur RA. A comparison of the diagnostic power of the full outline of unresponsiveness scale and the Glasgow coma scale in the discharge outcome prediction of patients with traumatic brain injury admitted to the Intensive Care Unit. Saudi J Anaesth. 2014;8(2):193-7.

Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58(4):585-93.

Johnson VD, Whitcomb J. Neuro/trauma intensive care unit nurses’ perception of the use of the full outline of unresponsiveness score versus the Glasgow coma scale when assessing the neurological status of Intensive Care Unit patients. Dimens Crit Care Nurs. 2013;32(4):180-3.

Said T, Chaari A, Hakim KA, Hamama D, Casey WF. Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically ill patients: a pilot study. Int J Crit Illn Inj Sci. 2016;6(4):172-7.

Bledsoe BE, Casey MJ, Feldman J, Johnson L, Diel S, Forred W, et al. Glasgow coma scale scoring is often inaccurate. Prehosp Disaster Med. 2015;30(1):46-53.

Ashkenazi I, Schecter WP, Peleg K, Givon A, Olsha O, Fuentes FT, et al. Glasgow coma scale score in survivors of explosion with possible traumatic brain injury in need of neurosurgical intervention. JAMA Surg. 2016;151(10):954-8.

Büyükcam F, Kaya U, Karakılıç ME, Cavuş UY, Sönmez FT, Odabaş O, et al. Predicting the outcome in children with head trauma: Comparison of FOUR score and Glasgow coma scale. Ulus Travma Acil Cerrahi Derg. 2012;18(6):469-73.

Wijdicks EFM. Clinical scales for comatose patients: the Glasgow coma scale in historical context and the new FOUR score. Rev Neurol Dis. 2006;3(3):109-17.

Gill M, Windemuth R, Steele R, Green SM. A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes. Ann Emer Med. 2005;45(1):37-42.

Ledoux D, Bruno M, Jonlet S, Choi P, Schnakers C, Damas F, et al. Full outline of unresponsiveness compared with Glasgow coma scale assessment and outcome prediction in coma. Critic Care. 2009;13:107.

Kevric J, Jelinek GA, Knott J, Weiland TJ. Validation of the full outline of unresponsiveness (FOUR) scale for conscious state in the emergency department: comparison against the Glasgow coma scale. Emer Med J. 2011;28(6):486-90.

Fugate JE, Rabinstein AA, Claassen DO, White RD, Wijdicks EFM. The FOUR score predicts outcome in patients after cardiac arrest. Neurocritic Care. 2010;13(2):205-10.

Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EFM. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clinic Proceeding. 2009;84(8):694-701.

Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emer Med J. 2006;23(5):372-5.

Khajeh A, Fayyazi A, Aliabad GM, Askari H, Noori N, Khajeh B, et al. Comparison between the ability of Glasgow coma scale and full outline of unresponsiveness score to predict the mortality and discharge rate of pediatric Intensive Care Unit patients. Iran J Pediatr. 2014;24(2):603-8.

Ramazani J, Hosseini M. Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit. Ann Card Anaesth. 2019;22(2):143-8.

Nair SS, Surendran A, Prabhakar RB, Chisthi MM. Comparison between FOUR score and GCS in assessing patients with traumatic head injury: a tertiary centre study. Int Surg J. 2017;4(2):656-62.

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Published

2021-11-26

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Section

Original Research Articles