A Comparative Study to Evaluate Prognostic Value of Glasgow Coma Score and Full Outline of Unresponsiveness Scale to Predict the Outcome of Unconscious Child in the Paediatric Intensive Care Unit

Abstract

Background: The current issue of improving mortality and care in paediatric patient is very challenging. Early anticipation and intervention will be helpful in improving the outcome in emergency and paediatric intensive care unit (PICU) by the use of Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score. Decreasing in GCS and FOUR score is associated with worsening level of consciousness. Aim: The Aim of the study was to compare the prognostic value of FOUR and GCS score in unconscious children to predict the survival in unconscious children to predict the morbidity pattern. Materials and Methods: The present observational study was done from June 2019 to June 2020 at PICU of Department of Paediatrics, BRD Medical College, Gorakhpur, following Ethical Clearance from the Institutional Ethics Committee of BRD Medical College. All the admitted unconscious children in PICU were included in our study. Data entry and analysis were done using SPSS. Data were analysed using appropriate statistical test. Results: In our study, 65 (50.0%) patients were 9–12 years old and male was predominant. Seventy-eight (60%) patients had symptoms of <3 days. GCS score of E, V, M response at the time of admission was assessed in which maximum patients seen in E2 i.e., 60 (46.2%), V2 50 (38.5%) patients and M5 47 (36.1%) patients, while after 12 h patients, maximum GCS were seen in E3 54 (41.5%) patients, V2 54 (41.5%) patients and M5 (42.3%) patients and after 72 h patients maximum GCS was seen in E4 80 (61.5%) patients, V 54 (41.5%) patients and M51 (39.2%) patients. FOUR score baseline eye response was maximum in E2 39 (30%), motor response in M2 76 (58.5%), brain stem function response in B4 118 (90.8%) and respiration response in R4 44 (33.8%). Similarly, after 12 h score was E3 44 (33.8%), M3 48 (36.9%), B4 74 (56.9%), R4 56 (44.4%) while after 72 h score was E3 75 (57.7%), M4 75 (57.7%), B4 88 (67.7%) and R4 88 (67.7%). On final diagnosis, maximum was of AES 40 (30.7%). Thirty-two patients expired during the study period. Conclusion: FOUR and GCS score both is the good predictor of severity of disease and of mortality and may help in prioritising the treatment of sick as well as the counselling of parents about disease severity.