Evaluation of the Clinical Usefulness of Critical Patient Severity Classification System and Glasgow Coma Scale for Neurological Patients in Intensive Care Units

AbstractRapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

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An observational study on use of Glasgow coma scale in neurology patients among staff nurses of the intensive care units and emergency departments in selected hospitals at Mangaluru

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v9i7.21 ◽

2021 ◽

Vol 09 (07) ◽

Author(s):

Mrs. Jonita Wilma Rodrigues ◽

Keyword(s):

Intensive Care ◽

Observational Study ◽

Glasgow Coma Scale ◽

Intensive Care Units ◽

Emergency Departments ◽

Staff Nurses ◽

Coma Scale

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Tradução e Validação da Escala FOUR para a Pediatria e o seu Uso Como Indicador Prognóstico: Um Estudo Piloto

Acta Médica Portuguesa ◽

10.20344/amp.8052 ◽

2017 ◽

Vol 30 (9) ◽

pp. 599 ◽

Cited By ~ 1

Author(s):

Sofia Simões Ferreira ◽

Daniel Meireles ◽

Alexandra Pinto ◽

Francisco Abecasis

Keyword(s):

Intensive Care ◽

Glasgow Coma Scale ◽

Intensive Care Units ◽

Adult Population ◽

Strong Association ◽

Pediatric Intensive Care ◽

Impaired Consciousness ◽

Pediatric Intensive Care Units ◽

Coma Scale ◽

Minimum Score

Introduction: The Full Outline of UnResponsiveness - FOUR scale has been previously validated to assess impaired consciousness in the adult population. The aim of this study is the translation into Portuguese and validation of the FOUR scale in the pediatric population. The study also compares the FOUR scale and Glasgow coma scale score ratings and the clinical outcome of patients hospitalized in Pediatric Intensive Care Units.Material and Methods: This study prospectively rated patients admitted to the Pediatric Intensive Care Units with impaired consciousness during one year. Both scales were applied daily to patients by three types of examiners: intensivists, residents and nurses, from the moment of admission until clinical discharge. Neurological sequelae was evaluated using the King’s Outcome Scale for Childhood Head Injury - KOSCHI.Results: Twenty seven patients between one and 17 years of age were included. Both scales are reliable and inter-rater reliability was greater for the FOUR score. Glasgow coma scale showed a minimum score in eight evaluations, whereas the FOUR scale obtained the minimum score in only two of these evaluations. In both scales there was a strong association between the admission score and the patient’s outcome (area under curve FOUR = 0.939, versus Glasgow coma scale = 0.925).Discussion: The FOUR scale provides more neurological information than Glasgow coma scale in patients with impaired consciousness and has prognostic interest.Conclusion: The FOUR scale can be applied in patients admitted with impaired consciousness in Pediatric Intensive Care Units. We think that a multicenter study would be very beneficial for confirming and generalizing these results.

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Sensitivity and Specificity of Full Outline of Unresponsiveness Score and Glasgow Coma Scale towards Patients’ Outcomes at the Intensive Care Units

IOSR Journal of Nursing and health Science ◽

10.9790/1959-0601031013 ◽

2017 ◽

Vol 06 (01) ◽

pp. 10-13 ◽

Cited By ~ 1

Author(s):

Ika Silvitasari ◽

Hery Djagat Purnomo ◽

Untung Sujianto

Keyword(s):

Intensive Care ◽

Glasgow Coma Scale ◽

Intensive Care Units ◽

Sensitivity And Specificity ◽

Coma Scale

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Neurological Severity Classification System (CSN-System) in adults with BTI, Hospital Cayetano Heredia, Lima - Peru, 2020. Preliminary study.

Peruvian Journal of Neurosurgery ◽

10.53668/2021.pjns33253 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Elder Castro ◽

◽

Rómulo Rodriguez

Keyword(s):

Glasgow Coma Scale ◽

Functional Status ◽

Classification System ◽

Brain Function ◽

Brain Injuries ◽

High Sensitivity ◽

Cross Sectional ◽

Coma Scale ◽

Severity Classification ◽

Neurosurgical Intervention

Objectives: Traumatic Brain Injury (TBI) is the disruption of brain function and architecture. The Glasgow Coma Scale (GCS) is the most widely used TBI severity classification; however, it assesses the functional status of the brain resulting from highly heterogeneous lesions and has little accuracy. The Neurological Severity Classification System (NSC System), a clinical-tomographic instrument designed to overcome lesion heterogeneity, assesses brain function and structure in determining the severity of BTI. Methods: Observational, prospective, and cross-sectional study in adults with BTI from the emergency service of the Cayetano Heredia Hospital, April - August 2020. It included patients aged 18 years or older with acute BTI. The NSC system was compared with the GCS in the BTI classification. Results: Of 29 patients, 82.76% were male and 82.76% were between 18 and 64 years old. The severity of the TBI through the NSC System was very mild 6.70%, mild 17.24%, moderate 51.72%, severe 17.24%, and critical 6.70%. There was an association between the NSC System and the Rotterdam Computed Tomographic Score (RCTS) (p = 0.005), a moderate positive correlation of the NSC System with the RCTS (Rho 0.6773, p = 0.0001), an association between the NSC System and the indication for neurosurgical intervention (p = 0.002), as well as high sensitivity-specificity in the distinction of severity categories with the NSC System, and lower GCS performance. Conclusions: The NSC clinical-tomographic system improves the determination of the severity of BTI in comparison with GCS and provides an excellent relationship with the indication for neurosurgical intervention. Keywords: Brain Injuries, Traumatic, Brain, Glasgow Coma Scale, Functional Status (Source: MeSH NLM)

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