Glasgow Coma Scale Versus Full Outline of UnResponsiveness Scale for Prediction of Outcomes in Patients with Traumatic Brain Injury in the Intensive Care Unit.

Abstract

Glasgow Coma Scale (GCS) is the most applied tool for classifying intensity of coma and predicting patient outcomes with traumatic brain injuries. The present study was conducted with the aim of comparing two criteria of Full Outline of UnResponsiveness (FOUR) scale and GCS in predicting prognosis in patients with traumatic brain injuries. In this prospective study, 198 patients with traumatic brain injuries were investigated. FOUR and GCS criteria for each patient were determined by four well-educated nurses. The area under receiver operating characteristic (ROC) curve was determined for in-hospital mortality outcomes. Of all patients, 65.2% survived and 34.8% died, and FOUR had correctly predicted 82% of them. FOUR had 0.76 sensitivity and GCS had a sensitivity 0.85. Mean scores for mortality and survival rates were 4.59±2.36 and 10.71±2.24 in GCS, and 3.15±3.52 and 12.77±2.43 in FOUR, respectively. The area under ROC curve was 0.961 for FOUR and 0.928 for GCS. The area under the curve was high for FOUR in scores 6 and 7, and for GCS in scores 5 and 6. FOUR score is a valuable, sensitive and specific diagnostic criterion for predicting outcomes in patients with traumatic brain injuries.