Comparison of Full Outline of UnResponsiveness Score and Glasgow Coma Scale in Predicting the Outcome of Children aged 3 to12 Years with Altered Level of Consciousness Admitted to the Paediatric Intensive Care Unit

Abstract

Introduction: The commonly used Glasgow Coma Scale (GCS) score for assessing consciousness has several shortcomings, especially in intubated patients. Recently, the Full Outline UnResponsive Score (FOUR) has been validated as an alternative to the GCS due to its additional benefits in evaluating brainstem reflexes and respiratory patterns. The use of the FOUR score can overcome the shortcomings of the GCS and aid in prognosticating patients with altered sensorium. Aim: To compare the FOUR score with GCS score to find a better scoring system for predicting outcomes among children aged 3-12 years with non-traumatic causes of Altered Level Of Consciousness (ALOC) in the hospital. Materials and Methods: A prospective cohort study was conducted on a total of 100 children with ALOC in the Paediatric Intensive Care Unit (PICU) of Gandhi Medical College and Hospital, Telangana, from December 2020 to November 2021. FOUR and GCS assessments were performed simultaneously within two hours of admission. For statistical analysis, continuous variables are expressed as mean±standard deviations. The predictive values of the GCS score and FOUR score were established using the Receiver Operating Characteristic (ROC) curve, by calculating the Area Under the Curve (AUC) with a 95% Confidence Interval (CI). Results: The mean age of the study population was 7.3±5.2 years, and the mean duration of hospital stay was 7.5±6.74 days. In-hospital mortality was 34%, and the survival rate was 66%. The mean FOUR score for in-hospital mortality and survival was 8.47±3.01 and 12.24±1.46, respectively (p-value <0.001). The mean GCS scores were 11.35±1.64 in survivors and 7.45 ±2.63 in non-survivors (p-value <0.001). A FOUR score of <10 was associated with higher mortality than a FOUR score of >10 (p<00.05). The Area Under Curve (AUC) for the FOUR score was 0.862 with a 95% CI (0.774 to 0.95) in the ROC curve (p-value <0.001), and for the GCS score, the AUC was 0.822 with a 95% CI (0.723 to 0.92) and p-value <0.001. The FOUR Score has a higher AUC than the GCS in the ROC curve, indicating that the FOUR Score has better discrimination than the GCS in outcome assessment. Conclusion: FOUR score and GCS score were comparable for predicting outcomes in children with ALOC. However, the FOUR score showed better discrimination than the GCS; hence, the FOUR score can be used as an alternative tool to the GCS for prognosis.