Abstract
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.
Highlights
Multiple traumas refer to severe damages affecting two or more organs
We investigated whether the Full outline of unresponsiveness (FOUR) score is better than Glasgow Coma Scale (GCS) in predicting mortality in patients with multi-traumatic injuries
We provided a check list for each patient which included the following information; age, sex, type of the trauma, emergency transferring device, shock index greater than 0.8 identified as compensated shock, shock stage was defined in three stages; Stage I, Stage II, and Stage III, FOUR score and GCS which were rated by the physician and the triage nurse, the prognosis of each patient and the duration of hospitalization
Summary
Multiple traumas refer to severe damages affecting two or more organs. The most possible organs in these kinds of injuries are head and neck as well as the extremities, while abdominal and thoracic damages could commonly happen [1]. We determined the prognostic value of the GCS and FOUR scores in a group of multi traumatic patients. We investigated whether the FOUR score is better than GCS in predicting mortality in patients with multi-traumatic injuries.
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