Full Outline of Unresponsiveness Score versus Glasgow Coma Scale in Assessing Patients with Isolated Traumatic Head Injury

BACKGROUND Traumatic head injury is one of the most common causes of mortality all over the world. Substantial initial assessment of head injury and its intensity in these patients is the primary goal for medical treatment. Hence, there is a necessity for a score better than GCS for the assessment of head injury patients. FOUR score, a new coma scale was published by Wijdicks in 2005. It included 4 components, motor response, eye response, brainstem reflex, and respiration. It precisely assesses the neurological activity as it includes the brain stem reflexes and eliminates the verbal component and identifies locked-in syndromes, temporal lobe herniations and third nerve dysfunctions which GCS fails to do so. We wanted to evaluate the correlation between FOUR score and GCS in evaluating the level of consciousness in patients with head injuries and evaluate the interobserver reliability of both the above-mentioned scores. METHODS This is an observational prospective study conducted on 92 patients with isolated traumatic head injury admitted to Department of General Surgery, VIMSAR, Burla, from November 2018 to October 2020. The parameters that were evaluated were clinical examination at the time of admission, were blood pressure (BP), temperature, pulse, and respiratory rate at the time of admission. Assessment of GCS and FOUR score at the time of admission, at 6 th hour, 24th hour and daily assessment till discharge. RESULTS A total of 92 isolated traumatic head injury patients were included in the study. Number of females (19.5 %) were significantly less when compared to males. The Pearson correlation coefficient between FOUR score and GCS was calculated to be 0.945, 0.962 and 0.951 respectively at the time of presentation, after 6 hours and isolated traumatic head injury. After 24 hours in patients with isolated traumatic head injury, Cohen’s weighted Kappa of GCS and FOUR score inter reliability was 0.956 and 0.985 respectively. Area under receiver operating characteristic curve (ROC) for GCS and FOUR score with Modified Rankins Score was 0.951 and 0.951. Area under ROC for mortality for GCS and FOUR score was 0.974 and 0.997 respectively. CONCLUSIONS As per our results, there is an excellent correlation between GCS and FOUR score in head injury patients. The FOUR score aims to overcome these shortcomings with a scale that is both simple to use and comprehensive in its overall neurologic assessment of the isolated traumatic head injury patients. FOUR score might prove to be a better tool to evaluate the consciousness of head injury patients and help in detection and stratification of these patients and in monitoring the efficiency of ongoing treatment. KEYWORDS Four Score, GCS, Head Injury

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

International Surgery Journal ◽

10.18203/2349-2902.isj20214759 ◽

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.

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Comparison between FOUR score and GCS in assessing patients with traumatic head injury: a tertiary centre study

International Surgery Journal ◽

10.18203/2349-2902.isj20170209 ◽

2017 ◽

Vol 4 (2) ◽

pp. 656 ◽

Cited By ~ 2

Author(s):

Sharath S. Nair ◽

Anilkumar Surendran ◽

Rajmohan B. Prabhakar ◽

Meer M. Chisthi

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Head Injuries ◽

Neurological Status ◽

Initial Assessment ◽

Traumatic Head Injury ◽

Mortality And Morbidity ◽

Coma Scale ◽

Tertiary Centre ◽

Traumatic Head

Background: Head injuries are a major cause of mortality and morbidity across the world. Effective initial assessment and early intervention is of importance in patients with traumatic brain injury, so as to ensure the maximum favorable outcome. Glasgow Coma Scale is the widely accepted scale to assess severity in head injury patients, albeit with many inadequacies. The objective of this study was to test the validity of full outline of unresponsiveness score, an alternate tool, in assessing severity in patients with traumatic brain injury.Methods: This was a descriptive study, conducted on 69 patients admitted to the general surgical and neuro-surgical wards of Government Medical College, Trivandrum, India with traumatic head injury. For all these patients, full outline of unresponsiveness score and Glasgow Coma Scale were calculated at the time of presentation and serially thereafter. The predictive value of full outline of unresponsiveness score as well as its correlation with Glasgow Coma Scale was studied.Results: A statistically significant correlation was found between full outline of unresponsiveness score and Glasgow Coma Scale in estimating the severity of head injury. Also Full Outline of unresponsiveness score was able to furnish better details about the neurological status of trauma patients.Conclusions: As per the results, it can be concluded that the full outline of unresponsiveness score can be applied as an ideal tool to evaluate consciousness levels and patients’ status in patients with traumatic head injury. It can be used as the ideal replacement for Glasgow Coma Scale.

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A study on correlation of degree of midline shift on CT scan and Glasgow coma scale in patients of acute traumatic head injury

International Journal of Research in Medical Sciences ◽

10.5455/2320-6012.ijrms20140877 ◽

2014 ◽

Vol 2 (3) ◽

pp. 1063

Author(s):

Akhilesh Ratnakar

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Ct Scan ◽

Midline Shift ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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Correlation Between Brain Imaging and Glasgow Coma Scale in Traumatic Head Injury in Pediatrics

International Journal of Medical Imaging ◽

10.11648/j.ijmi.20150303.14 ◽

2015 ◽

Vol 3 (3) ◽

pp. 63

Author(s):

Mohamed Labib Ahmed El Moghier

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Brain Imaging ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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A STUDY ON CORRELATION OF DEGREE OF MIDLINE SHIFT ON CT SCAN AND GLASGOW COMA SCALE IN PATIENTS OF ACUTE TRAUMATIC HEAD INJURY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i8.1371 ◽

2020 ◽

Vol 4 (8) ◽

Author(s):

Sandeep Kumar ◽

Narendra Kumar Kardam ◽

Kushal babu Gahlot ◽

Manphhol Singh Maharia

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Ct Scan ◽

Subdural Hematoma ◽

Midline Shift ◽

Extradural Hematoma ◽

Traumatic Head Injury ◽

Coma Scale ◽

Depressed Fracture ◽

Traumatic Head

Background: The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Results: External injury of scalpel is seen in 92% of cases, blackening of eye in 50% & vomiting in 50%. Cerebral contusion (50%) was the most common CT scan finding followed by depressed fracture (32%), subdural hematoma (22%) than extradural hematoma (6%). Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusions: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome. Keywords: CT scan, Glasgow coma scale, acute traumatic head injury.

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Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood

PLoS ONE ◽

10.1371/journal.pone.0082245 ◽

2013 ◽

Vol 8 (12) ◽

pp. e82245 ◽

Cited By ~ 11

Author(s):

Natasha L. Heather ◽

José G. B. Derraik ◽

John Beca ◽

Paul L. Hofman ◽

Rangi Dansey ◽

...

Keyword(s):

Early Childhood ◽

Head Injury ◽

Glasgow Coma Scale ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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Understanding and application of the glasgow coma scale amongst health care professionals caring for patients with traumatic head injury

International Journal of Surgery ◽

10.1016/j.ijsu.2015.07.526 ◽

2015 ◽

Vol 23 ◽

pp. S111-S112

Author(s):

J. Jeffery ◽

E. Stirling ◽

I. Al-Hadad ◽

M. Mussa ◽

J. Auld ◽

...

Keyword(s):

Health Care ◽

Head Injury ◽

Glasgow Coma Scale ◽

Health Care Professionals ◽

Traumatic Head Injury ◽

Coma Scale ◽

Traumatic Head

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Outcome of traumatic head injury in unknown patients

International Surgery Journal ◽

10.18203/2349-2902.isj20180366 ◽

2018 ◽

Vol 5 (2) ◽

pp. 633

Author(s):

Ankit Ahuja ◽

Siddhartha Verma ◽

Aditya Narayan Chaudhary

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Head Injuries ◽

Traumatic Head Injury ◽

Organ Systems ◽

Traumatic Head ◽

Gcs Score ◽

Discharge From Hospital ◽

Time Of Admission

Background: Traumatic brain injury is the most common cause of death in trauma victims accounting for about half of deaths at the accident site. Most commonly, traumatic brain injury occurs in the presence of additional injuries to other major organ systems, but it can also occur in isolation. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The objective of this study was to determine the outcome of traumatic head injury in patients admitted in the Department of Neurosurgery as unknown.Methods: All patients admitted as “unknown” to Neurosurgery department with traumatic head injury were studied retrospectively. Data was collected regarding demography, mode of injury, clinical presentation at the time of admission, management and outcome of these patients.Results: Data pertaining to 107 unknown patients were collected. Most patients were found to be males in 3rd decade of their lives with vehicular accidents as the common mode of injury. Patients presenting with Glasgow coma scale (GCS) score <8 at the time of admission had poor outcome and associated with higher mortality. Intra-cranial hemorrhage were predominantly found on CT scan. Only one-third of the patients were discharged after treatment while half of them suffered untimely death.Conclusions: Outcome of these neglected patients is poorer in comparison to patients who are accompanied by their relatives. Their management from pre-hospital to treatment and discharge from hospital is fraught with challenges. They need special care from trained nursing staff as well as help from social workers for recovery and rehabilitation.

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