Full Outline Of Unresponsiveness Score Research Articles

Comparison of the Prognostic Accuracy of Full Outline of Unresponsiveness (FOUR) Score with Glasgow Coma Scale (GCS) Score among Patients with Traumatic Brain Injury in a Tertiary Care Center

Abstract Objectives The Glasgow Coma Scale (GCS) is widely used and considered the gold standard in assessing the consciousness of patients with traumatic brain injury. However, some significant limitations, like the considerable variations in interobserver reliability and predictive validity, were the reason for developing the Full Outline of Unresponsiveness (FOUR) score. The current study aims to compare the prognostic accuracy of the FOUR score with the GCS score for in-hospital mortality and morbidity among patients with traumatic brain injury. Materials and Methods A prospective cohort study was conducted, where 237 participants were selected by consecutive sampling from a tertiary care center. These patients were assessed with the help of GCS and FOUR scores within 6 hours of admission, and other clinical parameters were also noted. The level of consciousness was checked every day with the help of GCS and FOUR scores until their last hospitalization day. Glasgow Outcome Scale was used to assess their outcome on the last day of hospitalization. The GCS and FOUR scores were compared, and data were analyzed by descriptive and inferential statistics. The chi-square test, independent Student's t-test, and receiver operating characteristic analysis were used for inferential analysis. Results The area under the curve (AUC) for the GCS score at the 6th hour for predicting mortality was 0.865 with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 64%. The AUC for FOUR scores at the 6th hour for predicting the mortality was 0.893, with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 73%. Conclusion The current study shows that, as per the AUC of GCS and FOUR scores, their sensitivity was equal, but specificity was higher in the FOUR score. So, the FOUR score has higher accuracy than the GCS score in the prediction of mortality among traumatic brain injury patients.

Evaluation of Prognostic Scores in Patients with Head Trauma in the Emergency Department

Background: The aim of this study was to investigate the effectiveness of Glasgow coma scale (GCS), GCS-motor component (mGCS), and FOUR (Full Outline of Un-responsiveness) Scores in predicting the prognosis of patients who presented to the emergency department with head trauma. Methods: In this prospective cross-sectional study, was obtained to collected data of patients with head trauma, who presented to the emergency department. Participants’ demographic data, medical history, GCS, FOUR scores, the duration of emergency department stays, as well as 24-hour, 7-day, and 28-day mortality rates were recorded on the case report forms. Results: Data from 302 patients were used to develop a risk score for detecting significant brain pathology via computed tomography (CT) scans. The regression model, incorporating total GCS and sex-based variables, explained 22.5% of variance and accurately classified 91.1% of cases. The model's area under the curve for detecting significant pathology via CT was 0.714. Conclusion: GCS, mGCS, and FOUR scores did not achieve the necessary the diagnostic performance benchmark to be used alone to predict or exclude clinically significant brain injury in patients with head trauma.

Beyond the GCS: an integrative review of new tools for neurological assessment in the intensive care unit for adult patients

The Glasgow Coma Scale (GCS) is a widely used clinical tool for assessing impaired consciousness, but concerns arise when applied to intubated patients or those receiving analgesics, sedatives, and paralytics because verbal scores are not evaluable. Furthermore, the GCS does not differentiate the neurological status of the patient once intubated, resulting in poor reliability in neurological assessment, and clinical indicators that may reflect the severity of the coma are not included in the GCS. This study explores alternative tools for neurological assessment in Intensive Care Units (ICUs) when GCS is impractical. Conducting an integrative review of studies from 2018 to 2022, we identified seven relevant papers. Results indicate the FOUR score as a promising GCS alternative, particularly in cases where the GCS is unavailable. Automated pupillometry also demonstrated the potential for monitoring neurologically impaired ICU patients. These tools, independent of verbal responses and applicable to sedated patients, offer improved accuracy in assessing consciousness. The study emphasizes the importance of adopting such alternatives, and addressing GCS limitations, and highlights the need for further research and implementation to enhance patient care in ICU settings.

Evaluating GCS and FOUR Score in Predicting Mortality of Traumatic Brain Injury Patients (TBI): A Prospective Study in a Tertiary Hospital of South Malabar

ABSTRACT Objective: This study evaluated the full outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) to predict traumatic brain injury (TBI) outcomes. Methods: Among 107 patients, FOUR and GCS grading systems analyzed emergency department patients within 24 hours. FOUR and GCS were assessed simultaneously. Patients were followed for 15 days/discharge/death to evaluate the results. Modified Rankin scores measured in-hospital mortality, morbidity, and stay. Results: 65.42% of patients were 25–65. 10% were under 25, and 25% were over 65. Patients were 81% male. Road traffic accidents (RTAs) (90%), falls (7.48%), and assaults (1.47%) caused TBI. 19.62% died. 85.7% of 21 non-survivors had GCS <5 and FOUR <4. GCS mortality sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.71%, 93.02%, 75, and 96.4 (P < 0.0001). FOUR score mortality sensitivity, specificity, PPV, and NPV were 85.71%, 96.51%, 85.7, and 96.5 (P < 0.0001). GCS and FOUR AUCs matched (P = 0.52). The unadjusted model reduced in-hospital mortality by 14% for every one point increase in GCS. Every 1-point FOUR score increase reduced in-hospital mortality by 40% in the unadjusted model. GCS and FOUR scored 0.9 Spearman. Conclusion: The FOUR score was comparable in the prediction of mortality in these patients.

Utility of the Full Outline of UnResponsiveness score in children with altered sensorium: A single-center prospective observational study

Background: Recent studies on the Full Outline of UnResponsiveness (FOUR) score suggest that it can overcome the limitations of the Glasgow Coma Scale (GCS). Hence, this study was planned to predict the outcome of children with altered sensorium using the FOUR score and to compare it with the GCS score. Subjects and Methods: This was a single-center prospective observational study conducted in children in the age group of ≥2 months–12 years with altered sensorium included in this study. Admission GCS and FOUR scores were collected. Data were analyzed to compare the FOUR score to GCS in relation to outcome (survivors/nonsurvivors). Results: Out of 90 cases with altered sensorium, 12 expired (13.3%). The mean (standard deviation [SD]) of age (years) was 4.69 (3.72) and the maximum in the age group of 1–5 years (n = 42). The mean (SD), median (interquartile range), and range for GCS at admission for survivors versus nonsurvivors were 11.58 (1.62) versus 6.08 (1.08), 12 (11–13) versus 6 (5.75–7), and 7–17 versus 4–8, and for FOUR score, 13.51 (1.46) versus 8.67 (1.50), 13 (13–15) versus 8 (7.75–10), and 9–16 versus 7–11 were observed, P < 0.001. Admission GCS score of ≤8 (12 out of 15) and FOUR score <11 (10 out of 12) died, P < 0.001. ROC curve analysis for mortality prediction, the area under the curve for GCS (cutoff of 8) was 0.992, and for the FOUR score (cutoff of 11), 0.989 was observed, P < 0.001. Conclusions: Admission FOUR and GCS scores are comparable for the prediction of mortality in children with altered sensorium. The FOUR score of ≤11 strongly correlated with mortality.

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

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.

Comparative study of the diagnostic power of full outline of unresponsiveness score and Glasgow coma scale in patients with traumatic brain injury in an emergency department

Background: The Glasgow coma scale (GCS) is the most commonly used scale, and the full outline of unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS to measure the level of consciousness and evaluate the severity of the injury in traumatic brain injury (TBI) patients. Aims and Objectives: The present study compared the performance of FOUR scores and GCS in outcome predictions of TBI cases. Materials and Methods: This prospective and cross-sectional study was conducted over a year by the Emergency Department of a tertiary care hospital, Kovai Medical Center and Hospital, Coimbatore, India. Of 159, 123 patients were recruited from intensive care unit (ICU), and 36 from the ward were included in this study. Data were collected using an observation checklist to determine the similarities and differences in predicting outcomes using the two assessment scales (GCS and FOUR). Results: Most patients were 51–60 years (38%), with a mean age of 41.57. About 82% were male, 18% were female, and 31% had comorbidity of hypertension. Data analysis showed a significant statistical difference in mean FOUR and GCS scores between ICU and ward admission. A multivariate logistic regression study revealed that the probability of ICU admission in trauma patients from the emergency department was associated with a decline in GCS and FOUR scores. The range of predicted ICU admission was similar in both GCS and FOUR score models. Conclusion: Although both scores are good predictors of TBI patients, we concluded that the FOUR score is a recommended predictive model for patients admitted to the medical ICU.

Correlation between bispectral index and FOUR score in critically ill patients with traumatic brain injury: A cross-sectional study

ABSTRACT Introduction For neurological testing and monitoring of traumatic brain injury (TBI) patients whose verbal component of the Glasgow Coma Scale (GCS) cannot be assessed, the Full Outline of Unresponsiveness (FOUR) score has been established. In order to determine the degree of awareness in patients with traumatic brain injury, this study will correlate the FOUR score with the bispectral index (BIS) and global consciousness score (GCS). Methods Twenty TBI patients with traumatic brain injury who were hospitalised to the surgical ICU at Cairo University Hospital participated in our prospective observational research. An observer who was blind to the BIS values assessed each of the FOUR scores and GCS (Covidien BIS complete monitoring system, Mansfield, MA, USA). Each patient provided four sets of readings. Spearman’s correlation coefficient was used to perform a correlation between the FOUR score, GCS, and BIS (r). Results There was a significant correlation between BIS and FOUR score (r = 0.854, 95% confidence interval: 0.780–0.904) (P < 0.001). There was also a significant correlation between BIS and GCS (r = 0.864, 95% confidence interval: 0.795–0.911) (P < 0.001). Conclusion There is a strong correlation between FOUR score, GCS, and BIS values in patients with traumatic brain injury. FOUR score seems a reliable alternative for GCS and BIS in the assessment of degree of consciousness, especially in intubated patients.

[Differential Diagnosis and Management of Disturbance of Consciousness:Approach to Comatose Patients].

Disorders of consciousness are among the most common symptoms in neurosurgery. A coma is an acute dysfunction of the nervous system that governs arousal and awareness and represents a medical emergency. Prompt evaluation and treatment of comas are fundamental in clinical practice. The first step is stabilizing the airway, breathing, and circulation while protecting the cervical spine to prevent secondary neurological injury. Subsequently, a focused neurological examination is performed. The level of consciousness, brainstem reflexes, respiratory patterns, motor responses, and muscle tone should be evaluated. Any asymmetry should be carefully considered. Acute disturbances of consciousness primarily impair arousal. The Japan and Glasgow Coma Scales are the most commonly used. The Emergency Coma Scale was designed by incorporating the advantages of each. The Full Outline of UnResponsiveness score incorporates brainstem reflexes and breathing patterns. Clinicians must have an organized approach to detect remediable causes, prevent neurological injury, and determine a hierarchical course of diagnostic testing, treatments, and neuromonitoring.

424 Comparison Between Glasgow Coma Scale and Full Outline of Unresponsiveness Score in Prediction of Trauma Patients' Outcome in Intensive Care Units

424 Comparison Between Glasgow Coma Scale and Full Outline of Unresponsiveness Score in Prediction of Trauma Patients' Outcome in Intensive Care Units

Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest

Background and objectivesBrain death (BD) occurs in 9–24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score. MethodsWe identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021. The BDR score ranges from 0 to 7 points and includes: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) radiology report within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1–5 (1 point), and age <45 years (1 point). We internally validated the BDR score using k-fold cross validation (k = 8) and externally validated the score at an independent academic center. The main outcome was BD. ResultsThe development cohort included 362OHCA patients, of whom 18% (N = 58) experienced BD. Internal validation provided an area under the receiving operator characteristic curve (AUC) (95% CI) of 0.931 (0.905–0.957). In the validation cohort, 19.8% (N = 17) experienced BD. The AUC (95% CI) was 0.849 (0.765–0.933). In both cohorts, a BDR score >4 was the optimal cut off (sensitivity 0.903 and 0.882, specificity 0.830 and 0.652, in the development and validation cohorts respectively). DiscussionThe BDR score identifies those at highest risk for BD after OHCA. Our data suggest that a BDR score >4 is the optimal cut off.

Nutritional Status of Patients with Chronic Critical Illness

Material and methods. We examined 23 patients with chronic critical illness who were in a minimally conscious state (MCS) with 10.9±2.5 scores on the FOUR (Full Outline of Unresponsiveness) Score Coma Scale. Indicators of carbohydrate, lipid, protein and energy exchange metabolism were evaluated using specimens sampled in the morning hours. Nutritional support was provided by isocaloric isonitrogenic mixtures.Results. Blood biochemistry showed decreases in total protein and albumin levels in 86.9% and 91.3% of patients, respectively. The tests also revealed decreased concentrations of several amino acids, including essential amino acids: histidine (38.3±13.07 µmol/l), methionine (12.68±3.81 µmol/l), threonine (61.6 [58.5;87.7] µmol/l), tryptophan (33.06±15.95 µmol/l), and non-essential amino acids: arginine (40.50 [22.2; 46.9] µmol/l), glutamic acid (124.5±39.29 µmol/l), tyrosine (37.97±10.12 µmol/l). Some correlations between the concentrations of individual amino acids and other indicators were revealed, such as histidine and CRP (r=–0.68, P=0.043), tryptophan and CRP (r=–0.86, P=0.002), histidine and leukocyte count (r=–0.76, P=0.015), methionine and lysine (r=0.88, P=0.008), methionine and patient's weight (r=–0.68, P=0.042). A relationship between threonine concentration and the level of consciousness on the FOUR scale (r=–0.73, P=0.037) was also found. All patients demonstrated significant alterations of carbohydrate and lipid metabolism.Conclusion. Alteration of adequate protein metabolism seems to be the most affected constituent in the nutritional status of patients with chronic critical illness. It is manifested by a decrease in the concentration of total protein and a number of essential and non-essential amino acids, which implies the importance of highprotein nutritional support and correction of the amino acid profile. 

Comparison of Full Outline of Unresponsiveness (FOUR) and Glasgow Coma Scale (GCS) in Determining Outcome among Patients in Critical Care Units – A Prospective Study

Accurate assessment and monitoring of level of consciousness is fundamental for prompt management and recognising warning signs of deterioration in the patient. The Glasgow coma scale (GCS), a widely used tool was compared with full outline of unresponsiveness (FOUR) score as an alternate tool for assessment and prognostication of the outcome. The purpose of this study aimed to compare and evaluate the accuracy between GCS and FOUR score (FS) tool in the neurological assessment and predicting the functional outcome. Materials and Methods: For this observational study, 131 patients were recruited from two major teaching hospitals in Middle Eastern countries. Data was collected on admission from emergency department and reassessed on day two &amp; four. Patient was followed on discharge and outcome evaluated using the Glasgow outcome scale (GOS). Results: The mean age was 56.39±17.29 (18- 87years) with 83(63.4%) male patients. 93 (71%) patients admitted with neurological problems. In terms of predicting the outcome using the GOS, the area under the ROC curve was 92% (CI- 95%, 0.870-0.975) for FS and 74.73 % (CI-95%, 0.825-0.951) for GCS. The sensitivity and specificity for FS on admission (0.976 &amp; 0.543), day two (0.971 &amp; 0.495) &amp; day four (0.971 &amp; 0.340) and for GCS is (0.918 &amp; 0.370) (0.941 &amp; 0.433) (0.971 &amp; 0.330). Conclusions: The FS tool is precise in predicting power of mortality and is an ideal complementary or substitute tool for GCS.

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India.

This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Acute traumatic coma awakening by right median nerve electrical stimulation: a randomised controlled trial

PurposeSevere traumatic brain injury (TBI) leads to acute coma and may result in prolonged disorder of consciousness (pDOC). We aimed to determine whether right median nerve electrical stimulation is a safe and effective treatment for accelerating emergence from coma after TBI.MethodsThis randomised controlled trial was performed in 22 centres in China. Participants with acute coma at 7–14 days after TBI were randomly assigned (1:1) to either routine therapy and right median nerve electrical stimulation (RMNS group) or routine treatment (control group). The RMNS group received 20 mA, 300 μs, 40 Hz stimulation pulses, lasting 20 s per minutes, 8 h per day, for 2 weeks. The primary outcome was the proportion of patients who regained consciousness 6 months post-injury. The secondary endpoints were Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness scale (FOUR), Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE) scores reported as medians on day 28, 3 months and 6 months after injury, and GCS and FOUR scores on day 1 and day 7 during stimulation. Primary analyses were based on the intention-to-treat set.ResultsBetween March 26, 2016, and October 18, 2020, 329 participants were recruited, of whom 167 were randomised to the RMNS group and 162 to the control group. At 6 months post-injury, a higher proportion of patients in the RMNS group regained consciousness compared with the control group (72.5%, n = 121, 95% confidence interval (CI) 65.2–78.7% vs. 56.8%, n = 92, 95% CI 49.1–64.2%, p = 0.004). GOSE at 3 months and 6 months (5 [interquartile range (IQR) 3–7] vs. 4 [IQR 2–6], p = 0.002; 6 [IQR 3–7] vs. 4 [IQR 2–7], p = 0.0005) and FOUR at 28 days (15 [IQR 13–16] vs. 13 [interquartile range (IQR) 11–16], p = 0.002) were significantly increased in the RMNS group compared with the control group. Trajectory analysis showed that significantly more patients in the RMNS group had faster GCS, CRS-R and DRS improvement (p = 0.01, 0.004 and 0.04, respectively). Adverse events were similar in both groups. No serious adverse events were associated with the stimulation device.ConclusionRight median nerve electrical stimulation is a possible effective treatment for patients with acute traumatic coma, that will require validation in a confirmatory trial.

Validation of the rCAST score and comparison to the PCAC and FOUR scores for prognostication after out-of-hospital cardiac arrest

AimEarly, accurate outcome prediction after out-of-hospital cardiac arrest (OHCA) is critical for clinical decision-making and resource allocation. We sought to validate the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score in a United States cohort and compare its prognostic performance to the Pittsburgh Cardiac Arrest Category (PCAC) and Full Outline of UnResponsiveness (FOUR) scores. MethodsThis is a single-center, retrospective study of OHCA patients admitted between January 2014-August 2022. Area under the receiver operating curve (AUC) was computed for each score for predicting poor neurologic outcome at discharge and in-hospital mortality. We compared the scores’ predictive abilities via Delong’s test. ResultsOf 505 OHCA patients with all scores available, the medians [IQR] for rCAST, PCAC, and FOUR scores were 9.5 [6.0, 11.5], 4 [3, 4], and 2 [0, 5], respectively. The AUC [95% confidence interval] of the rCAST, PCAC, and FOUR scores for predicting poor neurologic outcome were 0.815 [0.763–0.867], 0.753 [0.697–0.809], and 0.841 [0.796–0.886], respectively. The AUC [95% confidence interval] of the rCAST, PCAC, and FOUR scores for predicting mortality were 0.799 [0.751–0.847], 0.723 [0.673–0.773], and 0.813 [0.770–0.855], respectively. The rCAST score was superior to the PCAC score for predicting mortality (p = 0.017). The FOUR score was superior to the PCAC score for predicting poor neurological outcome (p < 0.001) and mortality (p < 0.001). ConclusionThe rCAST score can reliably predict poor outcome in a United States cohort of OHCA patients regardless of TTM status and outperforms the PCAC score.

Comparative analysis between GCS (Glasgow coma scale) and FOUR (Full Outline of Unresponsiveness) score in preliminary assessment and prognostication of traumatic brain injury

Introduction: Head injury is one of the most critical conditions and has a serious neurological outcome if not treated promptly. Effective initial assessment and timely intervention ensures a favourable outcome. To achieve this, many assessment scoring systems have been devised over the years of which Glasgow coma scale (GCS) is the most widely used but it does have a few drawbacks. A newer coma scale, the FOUR score (Full Outline of UnResponsiveness) evaluates four components. The aim of the present study is to compare the GCS and FOUR score in traumatic head injury patients in predicting the better outcome. The outcome scoring is done by GCOS (Glasgow Coma Outcome Scale). Methods and Materials: One twenty-five patients with traumatic head injury were recruited between September 2019 to September 2021 in a tertiary health care centre. For all these cases, GCS and FOUR score on the day of arrival in emergency department (ED) was calculated by residents attending the case in ED and the outcome was scored using GCOS. The correlation between all three scores was then calculated. Results: The present study revealed the major cause of traumatic head injury as road traffic accidents and most of them being males. A significant strong positive correlation was found in FOUR score when compared with GCS in the prediction of outcome in traumatic brain injury patients. Conclusion: It was concluded that the FOUR score is more beneficial to that of GCS and can be used in outcome assessment in traumatic head injury and intubated patients. Thus, FOUR score is a better tool for prognostication.

Multimodal Prediction of Favorable Outcome After Cardiac Arrest: A Cohort Study.

Prognostic guidelines after cardiac arrest (CA) focus on unfavorable outcome prediction; favorable outcome prognostication received less attention. Our aim was to identify favorable outcome predictors and combine them into a multimodal model. Retrospective analysis of prospectively collected data (January 2016 to June 2021). Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Brigham and Women's Hospital, Boston, MA). Four hundred ninety-nine consecutive comatose adults admitted after CA. None. CA variables (initial rhythm, time to return of spontaneous circulation), clinical examination (Full Outline of UnResponsiveness [FOUR] score at 72 hr, early myoclonus), electroencephalography (EEG) (reactivity, continuity, epileptiform features, and prespecified highly malignant patterns), somatosensory-evoked potentials, quantified pupillometry, and serum neuron-specific enolase (NSE) were retrieved. Neurologic outcome was assessed at 3 months using Cerebral Performance Category (CPC); 1 and 2 were considered as favorable outcome. Predictive performance of each variable toward favorable outcomes were calculated, and most discriminant items were combined to obtain a multimodal prognostic score, using multivariable ordinal logistic regression, receiving operator characteristic curves, and cross-validation. Our analysis identified a prognostic score including six modalities (1 point each): 1) early (12-36 hr) EEG not highly malignant, 2) early EEG background reactivity, 3) late (36-72 hr) EEG background reactivity and 4) continuity, 5) peak serum NSE within 48 hours less than or equal to 41 µg/L, and 6) FOUR score greater than or equal to 5 at 72 hours. At greater than or equal to 4 out of 6 points, sensitivity for CPC 1-2 was 97.5% (95% CI, 92.9-99.5%) and accuracy was 77.5% (95% CI, 72.7-81.8%); area under the curve was 0.88 (95% CI, 0.85-0.91). The score showed similar performances in the validation cohort. This study describes and externally validates a multimodal score, including clinical, EEG and biological items available within 72 hours, showing a high performance in identifying early comatose CA survivors who will reach functional independence at 3 months.

Prediction of Mortality using Full Outline of Unresponsiveness Versus Glasgow Coma Scale Scores in Traumatic Brain Injury Patients: An Observational Comparative Study

Introduction: Traumatic Brain Injury (TBI) is an alteration in the brain's normal function that an external force can cause. The most reliable outcome prediction is essential to portray the burden of TBI. Hence, the present study compared two scores of the Full Outline of UnResponsiveness (FOUR) scale and GCS in predicting mortality in patients with traumatic brain injuries. Methodology: A comparative observational study was conducted with 60 patients with traumatic brain injury who matched with inclusion criteria at the Intensive care unit of Saveetha Medical College and Hospital. The mortality rate was predicted by measuring the responses mentioned in the Full Outline of Unresponsiveness (FOUR) scale and Glasgow Coma Scale daily from the day of admission to till seven days. Results Both scale was statistically effective in predicting mortality rate. The predicted mortality rate on all seven days using the FOUR score was statistically (p

A Comparative Study to Evaluate Prognostic Value of Glasgow Coma Score and Full Outline of Unresponsiveness Scale to Predict the Outcome of Unconscious Child in the Paediatric Intensive Care Unit

Background: The current issue of improving mortality and care in paediatric patient is very challenging. Early anticipation and intervention will be helpful in improving the outcome in emergency and paediatric intensive care unit (PICU) by the use of Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score. Decreasing in GCS and FOUR score is associated with worsening level of consciousness. Aim: The Aim of the study was to compare the prognostic value of FOUR and GCS score in unconscious children to predict the survival in unconscious children to predict the morbidity pattern. Materials and Methods: The present observational study was done from June 2019 to June 2020 at PICU of Department of Paediatrics, BRD Medical College, Gorakhpur, following Ethical Clearance from the Institutional Ethics Committee of BRD Medical College. All the admitted unconscious children in PICU were included in our study. Data entry and analysis were done using SPSS. Data were analysed using appropriate statistical test. Results: In our study, 65 (50.0%) patients were 9–12 years old and male was predominant. Seventy-eight (60%) patients had symptoms of &lt;3 days. GCS score of E, V, M response at the time of admission was assessed in which maximum patients seen in E2 i.e., 60 (46.2%), V2 50 (38.5%) patients and M5 47 (36.1%) patients, while after 12 h patients, maximum GCS were seen in E3 54 (41.5%) patients, V2 54 (41.5%) patients and M5 (42.3%) patients and after 72 h patients maximum GCS was seen in E4 80 (61.5%) patients, V 54 (41.5%) patients and M51 (39.2%) patients. FOUR score baseline eye response was maximum in E2 39 (30%), motor response in M2 76 (58.5%), brain stem function response in B4 118 (90.8%) and respiration response in R4 44 (33.8%). Similarly, after 12 h score was E3 44 (33.8%), M3 48 (36.9%), B4 74 (56.9%), R4 56 (44.4%) while after 72 h score was E3 75 (57.7%), M4 75 (57.7%), B4 88 (67.7%) and R4 88 (67.7%). On final diagnosis, maximum was of AES 40 (30.7%). Thirty-two patients expired during the study period. Conclusion: FOUR and GCS score both is the good predictor of severity of disease and of mortality and may help in prioritising the treatment of sick as well as the counselling of parents about disease severity.