scholarly journals Full outline of unresponsiveness versus Glasgow coma scale in predicting mortality in paediatric trauma patients

2019 ◽  
Vol 6 (7) ◽  
pp. 2279
Author(s):  
Rania Salah ◽  
Tamer Fakhri ◽  
Ahmed Gaber
Keyword(s):  
Glasgow Coma Scale ◽  
Roc Curve ◽  
High Accuracy ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Coma Scale ◽  
Paediatric Patients ◽  
Four Score ◽  
Gcs Score

Background: Many scoring models have been proposed for evaluating level of consciousness in trauma patients. The aim of this study is to compare Glasgow coma scale (GCS) and full outline of unresponsiveness (FOUR) score in predicting the morbidity and mortality of trauma paediatric patients.Methods: In this diagnostic accuracy study trauma paediatric patients hospitalized in emergency room (ER) of Menoufia University hospital were evaluated. GCS and FOUR score of each patient were simultaneously calculated on admission as well as 6, 12 and 24 hours after that. The predictive values of the two scores and their area under the receiver operating characteristics (ROC) curve were compared.Results: 100 patients were included in the present study (mean age 7.6±5.1; 77% male). Comparing the area under the ROC curve of GCS and FOUR score showed that these values were not different at any of the evaluated times: on admission (p=0.68), and 6 hours (p=0.13), 12 hours (p=0.18). However, The values of FOUR score was high accuracy than GCS score in predicting mortality in paediatric patients with ROC; 0.97, 0.89 respectively.Conclusions: The results of our study showed that, GCS and FOUR score have the same value in predicting the mortality of trauma patients in first 24 hours. However, FOUR score has high accuracy than GCS score after 24 hours. Both tools had high predictive power in predicting the outcome at the time of discharge.

scholarly journals Comparison of interrater reliability and predictive validity of FOUR score and Glasgow Coma Scale in multi traumatic patients

2017 ◽  
Vol 5 (4) ◽  
pp. 17 ◽  
Author(s):  
Samad Shams Vahdati ◽  
Jafar Ghobadi ◽  
MohammadReza Bazavar ◽  
Fatemeh Seifar
Keyword(s):  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Mean Value ◽  
Trauma Patients ◽  
Rater Reliability ◽  
Coma Scale ◽  
Duration Of Hospitalization ◽  
Predicting Outcome ◽  
Four Score ◽  
Gcs Score

Background: Multi traumatic injuries impose health care concern and major burden for society. The Glasgow Coma Scale (GCS) is a routine scale for assessing levels of consciousness and prognosis of traumatic patients. The Full outline of unresponsiveness (FOUR) score is a new coma scale developed to overcome the limitations of GCS. In this prospective study, we aimed to compare the predicting outcomes and inter-rater reliability of the GCS and FOUR score in a group of multi traumatic patients. 96 consecutive multi trauma patients admitted in emergency departments were enrolled in the study. GCS and FOUR score were documented on arrival to the emergency room. Their correlation with patients ‘outcomes was analyzed. In terms of predictive power for in-hospital mortality, calculated mortality rate was 33.1 for FOUR score and 30.21 for GCS. Mean value of GCS and FOUR score were 14.83 and 13.68, respectively. Mortality rate was determined 9.3% and mean duration of hospitalization was 7.86±8.73 days. In addition, inter-rater reliability was determined κ = 0.84 ± 0.01 for GCS score and κ = 0.86 ± 0.01 for FOUR score rating. Inter-rater reliability and outcome predictability for FOUR score was superior to the GCS in this study, therefore FOUR score can be considered as a viable alternative to the GCS in the emergency department by accurately predicting outcome and improving the quality of management in trauma patients. 

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 Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

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. 

scholarly journals Combination of neuron-specific enolase measurement and initial neurological examination for the prediction of neurological outcomes after cardiac arrest

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jae Hoon Lee ◽  
Yong Hwan Kim ◽  
Jun Ho Lee ◽  
Dong Woo Lee ◽  
Seong Youn Hwang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Glasgow Coma Scale ◽  
Primary Endpoint ◽  
Neurological Examination ◽  
Neuron Specific Enolase ◽  
Coma Scale ◽  
Neurological Outcomes ◽  
Four Score ◽  
Auc Value ◽  
Gcs Score

AbstractThis study aimed to investigate the efficacy of the combination of neuron-specific enolase (NSE) measurement and initial neurological examination in predicting the neurological outcomes of patients with cardiac arrest (CA) by retrospectively analyzing data from the Korean Hypothermia Network prospective registry. NSE levels were recorded at 48 and 72 h after CA. The initial Full Outline of UnResponsiveness (FOUR) and Glasgow Coma Scale (GCS) scores were recorded. These variables were categorized using the scorecard method. The primary endpoint was poor neurological outcomes at 6 months. Of the 475 patients, 171 (36%) had good neurological outcomes at 6 months. The areas under the curve (AUCs) of the categorized NSE levels at 72 h, GCS score, and FOUR score were 0.889, 0.722, and 0.779, respectively. The AUCs of the combinations of categorized NSE levels at 72 h with categorized GCS scores and FOUR score were 0.910 and 0.912, respectively. Each combination was significantly higher than the AUC value of the categorized NSE level at 72 h alone (with GCS: p = 0.015; with FOUR: p = 0.026). Combining NSE measurement and initial neurological examination improved the prediction of neurological outcomes.

scholarly journals CAN FULL OUTLINE OF UNRESPONSIVENESS SCORE (FOUR) REPLACE GLASGOW COMA SCALE (GCS) IN HEAD INJURY?: VALIDATION AT TERITIARY CARE CENTRE IN NEPAL

2018 ◽  
Vol 6 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Prakash Kafle ◽  
Mohan Raj Sharma ◽  
Sushil K Shilpakar ◽  
Gopal Sedain ◽  
Amit Pradhanang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Outcome Measurement ◽  
University Teaching ◽  
Predictive Values ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Four Score

Introduction : Traumatic brain injury (TBI) is one of the major cause of severe disability and death world wide.The mortality rate in these patients largely depends on initial severity of trauma. In TBI, initial level of consciousness is most important prognostic indicator. The commonest scale is the Glasgow Coma Scale (GCS). Despite its widespread use, the GCS has some significant limitations, including variations in inter rater reliability and predictive validity. In order to overcome deficiencies of the GCS, an alternative scale called FOUR (Full Outline of Unresponsiveness score) has been developed and validated in several neurosurgical centers in North America. This study was an attempt to validate this score in Nepalese Setting.  This study was carried out in the Department of Neurosurgery at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The main objective ofthe study was to compare the FOUR with GCS in predicting outcome in patients with Traumatic brain injury.MATERIAL AND METHODS: Patients with moderate to severe head injury aged 2: 16 years admitted in the Department ofNeurosurgery were eligible to participate in the study.The GCS and FOUR score were measured at the earliest possible time during admission by the single observer. Glasgow Outcome Scale (GOS) was measured at discharge and at 3 months follow up. Mortality was used as the primary outcome measure.RESULTS: Total  of 122 patients were included in the study. The mean age of the study population was 38.7 ± 18 years. Mean GCS score among survivors was higher than that among non-survivors which was statistically significant (10.9 ± 2 vs. 6 ± 1.12 (p <0.001). Similarly mean FOUR score among survivors was significantly higher than that among non-survivors ( 12. 8±2.49 vs. 6.08 ± 1.72 (p< 0.001). The cut off point for GCS and FOUR score were ≤ 7and ≤ 8 respectively. The area under ROC curve for GCS for prediction of mortality was 0.975 (95% CI; 0.947-1.000; p<0.001) and for FOUR score was 0.981 (95% CI; 0.960-1.000; p<0.001) suggesting good discrimination ability ofboth models.The overall sensitivity, specificity, positive predictive value and negative predictive values of GCS were 91.67%, 91.82%, 55% and 99% respectively while that for FOUR score were 100%, 91.82%, 57.1 % and 100%respectively.CONCLUSION: The outcome measurement of FOUR score was comparable with the GCS in traumatic brain injury and both the scores correlated well.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 32-39 

scholarly journals The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data

2018 ◽  
Vol 15 (11) ◽  
pp. 2346 ◽  
Author(s):  
Shao-Chun Wu ◽  
Cheng-Shyuan Rau ◽  
Spencer Kuo ◽  
Peng-Chen Chien ◽  
Hsiao-Yun Hsieh ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Predictive Accuracy ◽  
Trauma Patients ◽  
Shock Index ◽  
Reverse Shock ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Gcs Score

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13

1993 ◽  
Vol 8 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Albert K. Hsiao ◽  
Stuart P. Michelson ◽  
Jerris R. Hedges
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Head Ct ◽  
Coma Scale ◽  
Number Of Patients ◽  
Gcs Score ◽  
Pharmacologic Agents

AbstractIntroduction:Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).Methods:A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of ≤13 was performed. A total of 120 patients met the inclusion and exclusion criteria.Results:A significant number of patients presenting with a GCS score of ≤9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10–13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.Conclusion:Patients with a presenting GCS score of ≤9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10–13 is problematic. Patients with a presenting GCS score of 10–13 must be evaluated individually and closely monitored. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.

scholarly journals Traumatic Brain Injury: Prognostic Value of Various Coma Scales, CT Scores & Their Comparison Based on Clinical Outcome

2021 ◽  
Vol 6 (3) ◽  
pp. 26-30
Author(s):  
Ashrit Reddy Cheruku ◽  
Suryanarayan Reddy V
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Group Iv ◽  
Coma Scale ◽  
Group I ◽  
Highly Sensitive ◽  
Four Score ◽  
Group Ii ◽  
Gcs Score

Background: Traumatic brain injury (TBI) is common, carries a high morbidity and mortality and has no specific treatment. The Glasgow coma scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury against which other scale are compared to overcome the disadvantages of GCS. Materials & Methods: This is Prospective Observational comparative study was conducted in total 128 who admitted with traumatic brain injury (TBI) in Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during the period from November 2016 to November 2018. Results: A total of 128 (112 males) patients were included in the study. Among SMS, 0 is highly sensitive (72.22%), 2 is highly specific (80.43%). In GCS score < 8 was highly sensitive (97.22%) & GCS score 9 - 12 was highly specific (82.61%). In this study Marshall CT score of 4 - 6 (group II) has mortality 43.55% & CT score 1 - 3 (group I) was 13.64%. Where as in Rotterdam CT score was significant mortality with score 4 - 6 (group II) was 56.25% & CT score of 1 - 3 (group I) was 24.11%. In FOUR score with GCS, on 1 day with FOUR score 13 - 16 (group IV) has 5.56%, day 3, 13 - 16 (group IV) has 3.45%, day 7, 13 - 16 (group IV) has 3.13% & day 21, 13 - 16 (group IV) only 3.45% has mortality rate. Conclusion: if SMS is high there is more chance of survival, this helps in patients immediate segregation of patients in casualty. Also conclude that FOUR score has a high degree of internal consistency & is an accurate predictor of Mortality and neurologic outcome in TBI patients. Keywords: Simplified Motor Score, Glasgow Coma Scale, Marshall CT, Rotterdam CT, FOUR scale.

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

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