scholarly journals Perbandingan Full Outline of Unresponsiveness Score dengan Glasgow Coma Scale dalam Menentukan Prognostik Pasien Sakit Kritis

Sari Pediatri ◽  
2016 ◽  
Vol 13 (3) ◽  
pp. 215
Author(s):  
Rismala Dewi ◽  
Irawan Mangunatmadja ◽  
Irene Yuniar
Keyword(s):  
Glasgow Coma Scale ◽  
Operating Characteristic ◽  
Coma Scale ◽  
Four Score

Latar belakang. Penilaian kesadaran penting dilakukan pada pasien anak dengan sakit kritis untuk memperkirakanprognosis. Modifikasi Glasgow Coma Scale (GCS) banyak digunakan untuk menilai kesadaran tetapi memilikiketerbatasan terutama pada pasien yang diintubasi. Terdapat skor alternatif baru yaitu Full Outline ofUnResponsiveness score (FOUR score) yang dapat digunakan untuk menilai kesadaran pasien terintubasi.Tujuan. Membandingkan FOUR score dengan GCS dalam menentukan prognosis pasien kritis, sehinggapemeriksaan FOUR score dapat digunakan sebagai alternatif pengganti GCS.Metode. Penelitian prospektif observasional pada anak usia di bawah 18 tahun yang dirawat di Unit PerawatanIntensif Anak RSCM dengan penurunan kesadaran. Waktu penelitian antara 1 Januari – 31 Maret 2011.Masing-masing subjek dinilai oleh 3 orang supervisor berbeda yang bekerja di Unit Perawatan Intensif Anak.Ketiga penilai diuji reliabilitas dalam menilai FOUR score dan GCS. Dibandingkan sensitivitas, spesifisitas, danreceiver operating characteristic (ROC) kedua sistem skor terhadap luaran berupa kematian di rumah sakit.Hasil. Reliabilitas tiap pasangan untuk FOUR score (FOUR 0,963; 0,890; 0,845) lebih baik daripadamodifikasi GCS (GCS 0,851; 0,740; 0,700). Terdapat hubungan yang bermakna antara besar skor danluaran kematian di rumah sakit dengan (pFOUR score = pGCS = 0,001). Nilai sensitivitas, spesifisitas, nilai prediksipositif dan negatif serta rasio kemungkinan positif masing-masing adalah 93%; 86%; 88%; 92%; 6,6. Areaunder curve (AUC) FOUR score 0,854 dan GCS 0,808Kesimpulan. Prediksi prognostik pada pasien yang dirawat di Unit Perawatan Intensif Anak dengan FOURscore lebih baik dibandingkan GCS.

FOUR score and Glasgow Coma Scale in predicting outcome of comatose patients: A pooled analysis

Neurology ◽  
2011 ◽  
Vol 77 (1) ◽  
pp. 84-85 ◽  
Author(s):  
E. F. M. Wijdicks ◽  
A. A. Rabinstein ◽  
W. R. Bamlet ◽  
J. N. Mandrekar
Keyword(s):  
Glasgow Coma Scale ◽  
Pooled Analysis ◽  
Coma Scale ◽  
Predicting Outcome ◽  
Four Score

Determination of Imminent Brain Death Using the Full Outline of Unresponsiveness Score and the Glasgow Coma Scale: A Prospective, Multicenter, Pilot Feasibility Study

2017 ◽  
Vol 35 (2) ◽  
pp. 203-207 ◽  
Author(s):  
Sergio Zappa ◽  
Nazzareno Fagoni ◽  
Michele Bertoni ◽  
Claudio Selleri ◽  
Monica Aida Venturini ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Death ◽  
Brain Stem ◽  
Deep Coma ◽  
Coma Scale ◽  
Four Score ◽  
Gcs Score ◽  
Brain Stem Reflexes ◽  
Pilot Feasibility Study

Purpose: To evaluate the accuracy of the imminent brain death (IBD) diagnosis in predicting brain death (BD) by daily assessment of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) with the assessment of brain stem reflexes. Materials and Methods: Prospective multicenter pilot study carried out in 5 adult Italian intensive care units (ICUs). Imminent brain death was established when the FOUR score was 0 (IBD-FOUR) or the GCS score was 3 and at least 3 among pupillary light, corneal, pharyngeal, carinal, oculovestibular, and trigeminal reflexes were absent (IBD-GCS). Results: A total of 219 neurologic evaluations were performed in 40 patients with deep coma at ICU admission (median GCS 3). Twenty-six had a diagnosis of IBD-FOUR, 27 of IBD-GCS, 14 were declared BD, and 9 were organ donors. The mean interval between IBD diagnosis and BD was 1.7 days (standard deviation [SD] 2.0 days) using IBD-FOUR and 2.0 days (SD 1.96 days) using IBD-GCS. Both FOUR and GCS had 100% sensitivity and low specificity (FOUR: 53.8%; GCS: 50.0%) in predicting BD. Conclusions: Daily IBD evaluation in the ICU is feasible using FOUR and GCS with the assessment of brain stem reflexes. Both scales had 100% sensitivity in predicting IBD, but FOUR may be preferable since it incorporates the pupillary, corneal, and cough reflexes and spontaneous breathing that are easily assessed in the ICU.

scholarly journals Penilaian Kesadaran pada Anak Sakit Kritis: Glasgow Coma Scale atau Full Outline of UnResponsiveness score?

Sari Pediatri ◽  
2016 ◽  
Vol 17 (5) ◽  
pp. 401
Author(s):  
Rismala Dewi
Keyword(s):  
Glasgow Coma Scale ◽  
Coma Scale ◽  
Four Score

Pemeriksaan neurologis tingkat kesadaran sangat penting untuk menilai secara komprehensif pasien anak sakit kritis, dan dapat memberikan informasi prognosis. Skala koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala koma telah dikembangkan dan di validasi untuk mengevaluasi tingkat kesadaran secara cepat, menilai beratnya penyakit dan prognosis terhadap morbiditas dan mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan baku emas saat memvalidasi skala koma yang baru. GCS mempunyai keterbatasan karena pasien yang terintubasi tidak dapat dinilai komponen verbal sehingga memengaruhi hasil penilaian. FOUR Score dikembangkan untuk mengatasi berbagai keterbatasan yang dimiliki GCS. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien-pasien yang terintubasi.

scholarly journals Performa Rapid Emergency Medicine Score dalam Memprediksi Outcome Pasien Trauma Kepala di Instalasi Gawat Darurat

2019 ◽  
Vol 30 (4) ◽  
pp. 302
Author(s):  
Didik Mulyono ◽  
Nurdiana Nurdiana ◽  
Rinik Eko Kapti
Keyword(s):  
Emergency Medicine ◽  
Glasgow Coma Scale ◽  
Receiver Operating Characteristic ◽  
Odds Ratio ◽  
Area Under Curve ◽  
Operating Characteristic ◽  
Severe Disability ◽  
P Value ◽  
Coma Scale ◽  
Purposive Sampling

<p><br />Rapid Emergency Medicine Score (REMS) merupakan suatu sistem skor yang telah digunakan secara luas di berbagai negara untuk memprediksi mortalitas pasien non bedah maupun trauma di Instalasi Gawat Darurat (IGD), tetapi belum diuji pada populasi yang spesifik pada trauma kepala. Tujuan penelitian ini untuk menilai performa REMS dalam memprediksi outcome pasien trauma kepala di IGD. Penelitian ini menggunakan desain observasi analitik dengan pendekatan retrospektif. Sampel menggunakan data rekam medis pasien dengan trauma kepala sedang-berat disesuaikan dengan kriteria inklusi dan eksklusi dan digunakan teknik purposive sampling yaitu sebanyak 181 responden. Analisis bivariat yang dilakukan pada penelitian ini menggunakan uji Somers'd, sedangkan analisis multivariat menggunakan regresi logistik ordinal. Selanjutnya, kemampuan untuk memprediksi outcome dinilai menggunakan analisis the area under the receiver operating characteristic (AUROC). Hasil uji bivariat menunjukkan bahwa nilai somers'd REMS sebesar 0,310 dengan p value &lt;0,001 dan arah hubungan positif dengan outcome pasien trauma kepala. Hasil regresi logistik ordinal menunjukkan parameter Glasgow Coma Scale (GCS) memperoleh Odds Ratio sebesar 0,7, artinya skor GCS yang rendah memiliki risiko memperoleh outcome death sebesar 0,7 kali lebih besar dibandingkan memperoleh outcome moderate disability, severe disability, persisten vegetatif state. Nilai Area Under Curve (AUC) REMS pada cut of point &gt;5 dengan sensitivitas 61,4 dan spesifisitas 77,8 adalah 0,753 (95% CI; 0,683-0,814. REMS menunjukkan performa yang baik dalam memprediksi outcome pasien trauma kepala.</p>

scholarly journals Efektifitas Antara Alat Ukur Coma Recovery Scale – Revised (Crs-R), Full Outline Unresponsiveness (Four) Score, dan Glasgow Coma Scale (Gcs) Dalam Menilai Tingkat Kesadaran Pasien di Unit Perawatan Intensif RSUD Raden Mattaher Jambi

2018 ◽  
Vol 2 (1) ◽  
pp. 68-74
Author(s):  
Dini Rudini
Keyword(s):  
Glasgow Coma Scale ◽  
Meta Analysis ◽  
Coma Scale ◽  
Consecutive Sampling ◽  
Four Score

Penilaian kesadaran penting dilakukan pada pasien yang mengalami penurunan kesadaran pada pasien di ICU, hal ini bertujuan untuk memperkirakan prognosis pada seorang pasien. Penentuan prognosis pasien di unit perawatan intensive merupakan suatu hal yang perlu diperhatikan. Jika terjadi kesalahan dalam menentukan prognosis maka dapat mengakibatkan kesalahan dalam pemberian terapi, khususnya yang berkaitan dengan pengobatan penyakit, berdasarkan studi meta - analysis terdapat  tiga alat ukur yang paling baik diantara alat-alat ukur lainnya yang digunakan untuk menilai tingkat kesadaran yaitu Glasgow Coma Scale (GCS), The Full Outline UnResponsiveness (FOUR) Score, Coma Recovery Scale - Revised (CRS-R). Ketiga alat ukur ini telah tervalidasi dan telah digunakan di beberapa rumah sakit oleh tenaga kesehatan. Dengan memperhatikan hal-hal tersebut, maka peneliti tertarik untuk melakukan penelitian di RSUD Raden Mattaher Jambi untuk melihat efektifitas antara alat ukur Coma Recovery Scale – Revised (CRS-R), Full Outline UnResponsiveness (FOUR) score, dan Glasgow Coma Scale (GCS)dalam menilai tingkat kesadaran pasien di unit perawatan intensif RSUD Raden Mattaher Jambi Tahun. Jenis penelitian yang digunakan oleh peneliti adalah penelitian studi perbandingan (comparative) dimana penelitian ini tidak memberikan perlakuan kepada subjek penelitian, penelitian ini hanya akan membandingkan 3 instrument pengkajian tingkat kesadaran. Rancangan penelitian yang digunakan adalah longitudinall, yaitu pengamatan tidak hanya dilakukan sekali. Pengambilan sampel pada penelitian ini dilakukan dengan consecutive sampling. Dalam penelitian ini menggunakan tiga instrument skala yaitu Coma Recovery Scale – Revised (CRS-R), Full Outline UnResponsiveness (FOUR) score, dan Glasgow Coma Scale (GCS). Analisis yang digunakan dalam penelitian ini adalah uji beda.Berdasarkan hasil penelitian dari 76 responden dengan penurunan kesadaran  Ada perbedaan validitas dan reliabilitas antara alat ukur Glasgow Coma Scale (GCS) dan Coma Recovery Scale – Revised (CRS-R) dalam menilai tingkat kesadaran pasien di Unit Perawatan Intensive RSUD Raden Mattaher Jambi tahun 2017 terdapat satu komponen pada alat ukur GCS yaitu respon verbal yang memiliki nilai kesepakatan antar penenliti yang moderate dan terdapat dua komponen dalam alat ukur CRS-R yaitu skala fungsi oromotor/verbal dan skala fungsi komunikasi yang memiliki nilai kesepakatan antar peneliti yang baik.

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

2021 ◽  
Vol 8 (12) ◽  
pp. 3583
Author(s):  
Fahad Ansari ◽  
Arvind Rai
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Youden Index ◽  
Traumatic Head Injury ◽  
Coma Scale ◽  
Medical College ◽  
Traumatic Head ◽  
Four Score ◽  
Gandhi Medical College ◽  
Gcs Score

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. 

Bispectral Index in predicting in-hospital mortality in patients with ischemic stroke: A methodological study

2020 ◽  
pp. 102490792090867
Author(s):  
Sultan Tuna Akgol Gur ◽  
Ilker Akbas ◽  
Muhammed Zubeyir Kose ◽  
Abdullah Osman Kocak ◽  
Alper Eren ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glasgow Coma Scale ◽  
Receiver Operating Characteristic ◽  
Bispectral Index ◽  
Charlson Comorbidity Index ◽  
Operating Characteristic ◽  
Coma Scale ◽  
Receiver Operating Characteristic Curves ◽  
Comorbidity Index ◽  
Receiver Operating

Background: Ischemic stroke is a leading cause of death and functional disability worldwide. Several clinical scores or stroke scales, biological test or markers, clinical signs, and radiological imaging have been performed to predict both worse neurologic outcome and mortality for ischemic stroke. Objectives: The aim of our study was to investigate the association between early Bispectral Index scores and in-hospital mortality in patients with ischemic stroke. Methods: This is a comparative prospective methodological study, in which we evaluated the predictive accuracies of Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index for in-hospital mortality of patients with ischemic stroke. Receiver operating characteristic analysis was used for comparing the accuracy of the scoring systems, areas under receiver operating characteristic curves were calculated, and Youden J index was used for estimating associated cut-off values. Results: Among the 80 ischemic stroke patients, in-hospital mortality rate was 38.8% (n = 31). The areas under receiver operating characteristic curves were 0.984, 0.960, and 0.863 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. The difference between areas under receiver operating characteristic curves for Bispectral Index and Glasgow Coma Scale was statistically similar. Besides, the difference between areas under receiver operating characteristic curves for Bispectral Index and Charlson Comorbidity Index, and the difference between areas under receiver operating characteristic curves for Glasgow Coma Scale and Charlson Comorbidity Index were statistically significant. The associated cut-off values were ⩽74, ⩽12, and >4 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. For these cut-off points, sensitivity and specificity of Bispectral Index were 93.6% and 95.9%, sensitivity and specificity of Glasgow Coma Scale were 100.0% and 83.7%, and sensitivity and specificity of Charlson Comorbidity Index were 83.9% and 69.4%, respectively. However, accuracy of Bispectral Index was 95.0%, accuracy of Glasgow Coma Scale was 90.0%, and accuracy of Charlson Comorbidity Index was 75.0. Conclusion: Knowledge of the risk factors for mortality in patients with ischemic stroke can help to identify which patients have a higher risk of fatal outcome. The Bispectral Index score improved discrimination and classified patients with higher mortality better than both Glasgow Coma Scale and Charlson Comorbidity Index.

scholarly journals Glasgow Coma Scale versus Full Outline of Unresponsiveness Scale in Predicting Discharge Outcomes of Traumatic Brain Injury

2019 ◽  
Vol 1 (4) ◽  
pp. 9
Author(s):  
Eman B. Kasem ◽  
Sahar Y. Mohammad ◽  
Dalia A. Amin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Essential Element ◽  
University Hospital ◽  
Discharge Data ◽  
Coma Scale ◽  
Discharge Outcomes ◽  
Valid Predictor ◽  
Four Score

Context: Neurological assessment is an essential element of early warning scores used to recognize and early save the lives of critically ill patients.Aim: This study aimed to compare the full outline of Unresponsiveness Scale and the Glasgow Coma Scale in predicting discharge outcomes in patients with traumatic brain injuryMethod: A comparative research design conducted at Neurosurgery Intensive Care Unit in El Fayoum University Hospital. The Study recruited a purposive sample of 100 adult patients with TBI. They assessed using three tools (Patients Profile Data Form, Level of Consciousness Assessment," and Tool Discharge Data Assessment Record).Results: GCS is superior to FOUR score in prediction of length of stay and full recovery without any squeal while they are the same in the prediction of motor disability and sensory impairment (physical impairment). FOUR score is superior to GCS in the prediction of mortalityConclusion: the FOUR score provides more neurologic details than the GCS and is a valid predictor of outcome in patients with TBI; thus, it could be considered as a future prognostic model. It recommended for using FOUR score for predicting outcomes in patients with traumatic brain injuries as a valid predictor of discharge outcomes after traumatic brain injury.

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