Analysis of diagnostic informative value of the Full Outline of UnResponsiveness Scale in patients with spontaneous supratentorial intracerebral hemorrhage

Abstract

The main purpose of the study was to verify the diagnostic informative value of the Full Outline of UnResponsiveness Scale in patients with SSICH based on the comparison with neuroimaging criteria of midline shift severity. Material and methods. Prospective cohort study of 138 patients in acute period of SSICH was conducted, which included clinical assessment (using the Full Outline of UnResponsiveness (FOUR) Scale and the Glasgow Coma Scale (GCS) scores) and neuroimaging estimation of cerebral injury severity. A comparative analysis of Spearman’s rank correlation coefficients (R) and different areas under the receiver operating characteristic curves (derived from the same cases) was conducted with the help of Z statistic. Results. The Full Outline of UnResponsiveness Scale was verified as a highly informative tool for the presence and severity of midline shift clinical detection (AUC > 0.80, P < 0.0001) in patients with SSICH, whereas the diagnostic informative value of the FOUR scale within the assessment of severe midline shift clinical signs was higher than that for mild midline shift detection (AUC = 0.97 ± 0.02 versus AUC = 0.84 ± 0.05 for septum pellucidum displacement, P = 0.0158; AUC = 0.99 ± 0.01 versus AUC = 0.92 ± 0.03 for pineal gland displacement, P = 0.0269). The Full Outline of UnResponsiveness Scale had a higher diagnostic informative value than the GCS as for the presence of midline shift clinical signs detection (AUC = 0.81 ± 0.03 versus AUC = 0.67 ± 0.04, P = 0.0002; accuracy 77.5 % versus 63.0 %, P = 0.0085), as well as for the clinical assessment of septum pellucidum displacement severity (AUC = 0.80 ± 0.04 versus AUC = 0.73 ± 0.05, P = 0.0286) and pineal gland displacement (AUC = 0.80 ± 0.05 versus AUC = 0.74 ± 0.05, P = 0.0306) in patients with midline shift <4 mm due to SSICH. Conclusions. The Full Outline of UnResponsiveness Scale is characterized by the higher diagnostic informative value in clinical detecting midline shift severity in patients with SSICH.