Prediction of outcomes among mechanically ventilated patients with acute traumatic brain injury

Abstract

Background Literature review cites that traumatic brain injury (TBI) worldwide is rising, mainly owing to injuries associated with the increased use of motor vehicles. TBI is a serious public health problem in Egypt. Although the Glasgow coma scale (GCS) is the most commonly used scale, the Full Outline of Unresponsiveness (FOUR) scale is a new coma scale as an alternative to GCS in the evaluation of the level of consciousness. Aim To compare the predicted outcomes among mechanically ventilated patients with acute TBI using the GCS and the FOUR scale. Research design A descriptive comparative design was used to achieve the aim of the study. Setting The study was conducted in one of the ICUs of Cairo University Hospitals. Patients and methods A purposive sample of 124 critically ill adult patients connected to mechanical ventilators and diagnosed as having acute TBI was used. Tools of data collection Three tools were used: tool I, an assessment form for patients with mechanically ventilated acute TBI; tool II, GCS, and tool III, FOUR scale. Results The mean age of the study sample was 29.02±3.41 years, 80.6% were males, and majority of them had road traffic accident as the cause of injury. There was a significant statistical difference between GCS and FOUR with respect to duration/days of connection to mechanical ventilation [GCS (P=0.000) and FOUR (P=0.001)]; no complications (P=0.000); seizure (P=0.000); meningitis (P=0.017); and seizure, brain edema, meningitis, and cerebral hemorrhage (P=0.000). Conclusion High sensitivity and specificity of the FOUR scale for patients’ outcomes (death/survival) were documented in comparison with the GCS. Recommendation Further studies have to be carried out to compare FOUR scale with other tools among a larger probability sample in different geographical locations on a national level.