Predictive value of full outline of unresponsiveness (FOUR) score and GLASGOW coma scale (GCS) in outcome of children aged 1-14 years admitted with altered sensorium

Abstract

Background: Evaluation of altered consciousness in children is a challenge and an important aspect of emergency care. There is no objective measure to communicate and document the severity of coma as distinct from vital signs. Various coma scales have been developed for recording depth of consciousness which are widely used in clinical practice in adults and children. Studies are conflicting on the best quick assessment tool for neurologic status. One of the newer tools is the Full Outline of Unresponsiveness (FOUR) score has been developed to assess the depth of coma in a more detailed manner than the Glasgow Coma Scale (GCS) scale. Objectives: The present study was taken to determine the predictive value of FOUR score and GCS in outcome of children aged 1–14 years presenting with altered sensorium. Materials and Methods: This prospective observational study was conducted in the teaching hospital of Haryana. A total of 150 children aged between 1 and 14 years were included. FOUR score and GCS were obtained within 1 h of admission. This assessment was repeated at 12th h and 24th h after admission. Children who left against medical advice were telephonically contacted to determine the final outcome, and they were called for 1-month follow-up. Results: The mean age was 6.64 ± 4.13 years. Seventy-nine (52.66%) patients were male and 71 (47.33%) were female. GCS at admission, 12th h, and 24th h was 7.76 ± 2.91, 7.22 ± 3.60, and 7.22 ± 4.57, respectively. The mean FOUR score was 10.12 ± 3.92 which decreased continuously at 12th h, 24th h, and finally, at discharge, i.e., 10.29 ± 8.13 (P > 0.05). A total of 53 (35.33%) patients expired and 97 (64.66%) were discharged. A total of 69 patients were admitted to the pediatric intensive care unit (PICU). The mean duration of PICU stay was 5.84 ± 5.25. Patients who expired had lesser GCS score as compared to FOUR score at the time of admission and 12th h, i.e., 5.79 ± 2.18 and 6.54 ± 3.40 and 4.20 ± 2.62 and 4.30 ± 3.70, respectively. The mean GCS at the time of admission was 5.79 ± 2.8 which decreased significantly to 0.679 ± 2.28 and FOUR score decreased from 6.54 ± 3.40 to 0.35 ± 2.21 at the time in expired (P &#A60; 0.001). Conclusions: FOUR score can be used as good as GCS for predicting the inhospital mortality. GCS and FOUR scores both have a significant correlation with death. The study shows an excellent degree of agreement between GCS and FOUR scores at admission, at 12th h, at 24th h, and at discharge. FOUR score has better odds for predicting mortality on admission and at 24th h, whereas GCS at 12th h is better than FOUR score at 12th h in predicting mortality.