scholarly journals Comparison of glasgow coma scale with full outline of unresponsiveness score in measuring consciousness level of endotracheal tube intubated patient in the intensive care unit

2018 ◽  
Vol 6 (6) ◽  
pp. 1882 ◽  
Author(s):  
Yosi Oktarina ◽  
Charles A. Simajuntak
Keyword(s):  
Glasgow Coma Scale ◽  
Endotracheal Tube ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Respiratory Pattern ◽  
Observational Research ◽  
Measurement Tool ◽  
Coma Scale ◽  
Consciousness Level ◽  
Four Score

Background: Assessment of consciousness level is a basic ability that medical personnel, especially doctors and nurses shall master. It is due to assessment of consciousness as a basis of clinical decision making and determining the patient's prognosis. There are various types of scales to measure consciousness level of patient. One of the most famous and most widely applied is Glasgow Coma Scale (GCS). However, the use of GCS is less precise in measuring consciousness level of patients, especially in Endotracheal Tube Intubated patients (ETT). Another measure of consciousness assessment is FOUR Score. In contrast to GCS, the use of four score as a measurement tool for consciousness assessment is still not yet familiar especially in Indonesia. Four score has different component with GCS where the four score component has no assessment of verbal response but it has brainstem and respiratory pattern assessment components.Methods: This research was an observational research using prospective non-experimental approach. The sampling technique used was consecutive sampling with a sample size of 33 people. Observation of the sample was undertaken at the same time. The instruments used in this research were GCS and FOUR Score observation sheet. Data analysis was performed by measuring the sensitivity, specificity, positive predictive value, negative predictive value and ROC.Results: Four Score has sensitivity of 86.7 specificity of 83.3 predictive positive value of 81.3 and negative predictive value 88.2 and under curve area of 0.848. Meanwhile, GCS has sensitivity of 80.0, specificity of 77.8, predictive positive value of 75, and negative predictive value of 82.4 and under curve area of 0.819.Conclusions: Four scores have a better assessment in measuring the consciousness level of ETT intubated patients.

scholarly journals Coma scales: a historical review

2010 ◽  
Vol 68 (6) ◽  
pp. 930-937 ◽  
Author(s):  
Ana Luisa Bordini ◽  
Thiago F. Luiz ◽  
Maurício Fernandes ◽  
Walter O. Arruda ◽  
Hélio A.G. Teive
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Predictive Value ◽  
Historical Review ◽  
Medical Community ◽  
Review Of The Literature ◽  
Chronological Order ◽  
Coma Scale ◽  
Four Score

OBJECTIVE: To describe the most important coma scales developed in the last fifty years. METHOD: A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. RESULTS: Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. DISCUSSION: Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

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.

scholarly journals A Comparison of the Predictive Value of the Glasgow Coma Scale and the Kampala Trauma Score for Mortality and Length of Hospital Stay in Head Injury Patients at a Tertiary Hospital in Uganda: A Diagnostic Prospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Herbert Ariaka ◽  
Joel Kiryabwire ◽  
Ssenyonjo Hussein ◽  
Alfred Ogwal ◽  
Emmanuel Nkonge ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Prospective Study ◽  
Hospital Stay ◽  
Predictive Value ◽  
Length Of Hospital Stay ◽  
Tertiary Hospital ◽  
Operating Characteristics ◽  
Coma Scale ◽  
Trauma Score

Introduction. The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, “severe” patients, when scoring below the threshold and a good outcome “non severe” patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda. Methods. A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient’s demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison. Results. The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay. Conclusion. Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.

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 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.

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