Full Outline Of Unresponsiveness Research Articles

Disorders of Consciousness

The components of consciousness are classically separated into two major groups: level of arousal and content of thought processes (better known as being awake and aware). Disorders can affect both components or can affect only the content of consciousness. Physicians assess consciousness indirectly by observing a patient’s response to stimuli. This chapter covers the clinical approach to the comatose patient, which discusses history, physical examination (general and neurologic), localization principles, bihemispheric syndromes, and brainstem syndromes. Diagnostic tests discussed include blood tests, tests of other body fluids, and neuroimaging (e.g., computed tomography, magnetic resonance imaging, functional neuroimaging and physiologic testing). Also discussed are prognosis and brain death. Figures illustrate the Full Outline of Unresponsiveness (FOUR) scale, the spectrum of pupil abnormalities and causes, as well as anatomic structures and dorsal and ventral pathways involved with the maintenance of consciousness. Tables include the Glasgow Coma Scale, blood gas abnormalities due to toxins, and prognostic factors in nontraumatic coma. This chapter contains 45 references.

A Comparison of Full Outline of UnResponsiveness Score with Glasgow Coma Scale Score in Predicting Outcomes among Patients with Altered Mental Status Admitted to the Critical Care Unit.

ABSTRACTAimComparison of the Full Outline of UnResponsiveness (FOUR) score with the Glasgow Coma Scale (GCS) score to find the better scoring system for predicting outcomes among altered sensorium patients in the critical care unit.Materials and methodsThis is a prospective observational study. It included 100 patients of altered sensorium, whose GCS and FOUR scores were calculated at admission and followed up till death or discharge to note the outcome. Individual demographics and diagnosis were recorded, and the results were analyzed statistically.ResultsThe correlation between the two scores was excellent, with the Spearman's correlation coefficient of 0.88. Discrimination ability of the two scoring systems, as assessed by the area under the receiver operating characteristic curve, was 0.778 for GCS score and 0.883 for FOUR score (p <0.001). When area under the curve (AUC) was calculated exclusively in stroke cases, it was 0.836 for GCS score and 0.944 for FOUR score. Among nonstroke cases, the AUC was 0.756 and 0.859, respectively. However, the 95% confidence limits were overlapping among the corresponding scores.ConclusionThe above study concludes that there is a good correlation between GCS and FOUR scores in predicting outcomes. Superiority of FOUR score could not be established statistically in view of overlapping confidence limits. However, it performed at par with GCS in prognosticating mortality among patients with altered sensorium.Clinical significanceIn critically ill patients with altered sensorium, explaining the prognosis to the attendants is a challenge for the physician. The commonly used GCS score has several shortcomings, especially in intubated patients. Use of the FOUR score can overcome these shortcomings and help in prognostication of these patients. In view of its good correlation with GCS score and equal efficacy in predicting outcomes in varied etiologies, it can be used as a good alternative to the GCS score.How to cite this articleJavvaji PK, Nagatham P, Venkata RR, Puttam H, John SK, Karavalla H, et al. A Comparison of Full Outline of UnResponsiveness Score with Glasgow Coma Scale Score in Predicting Outcomes among Patients with Altered Mental Status Admitted to the Critical Care Unit. Indian J Crit Care Med 2022;26(2):210–215.

Prediction of Mortality in the Medical Intensive Care Unit with Serial Full Outline of Unresponsiveness Score in Elderly Patients.

BackgroundAdvanced age is one of the key risk factors for mortality and morbidity in intensive care units. The full outline of unresponsiveness (FOUR) score has been developed and introduced to address the limitations of the Glasgow Coma Scale (GCS). The current study aimed to evaluate the ability of the FOUR score in predicting the outcomes (survivors, nonsurvivors).Materials and methodsThis observational study of 168 consecutive elderly patients admitted to medical intensive care during the 14 months carried out prospectively. FOUR score in the 24, 48, and 72 hours of admission, and demographic characteristics of all elderly patients were calculated, then recorded. The receiver operating characteristic (ROC) curve, logistic regression, and Hosmer-Lemeshow test were used (95% confidence interval) for statistical analysis.ResultsFOUR scores in 24, 48, and 72 hours between survivors and nonsurvivors (p <0.0001, p <0.0001, and p <0.0001, respectively) were statistically different. The discrimination power of FOUR score 24 hours of admission was excellent [area under ROC (AUC): 85.7% [standard error (SE)]: 2.8%]; it was acceptable for 48 and 72 hours of admission [AUC: 76.3% (SE: 3.6%), AUC: 75/0% (SE: 3.8%), respectively]. The FOUR score of 24 and 48 hours (x2 = 10.06, p = 0.261, x2 = 6.82, p = 0.448, respectively) showed acceptable calibration.ConclusionsThe FOUR score is a suitable scoring system for prognostication of outcomes in critically ill elderly patients. The FOUR score 24 hours of admission was superior in terms of discrimination power than 48 and 72 hours, but better calibration power belonged to FOUR score 48 hours.How to cite this articleRamazani J, Hosseini M. Prediction of Mortality in the Medical Intensive Care Unit with Serial Full Outline of Unresponsiveness Score in Elderly Patients. Indian J Crit Care Med 2022;26(1):94–99.

HIV Infection Is an Independent Predictor of Mortality Among Adults with Reduced Level of Consciousness in Uganda.

ABSTRACT.The clinical epidemiology of adults admitted with reduced level of consciousness (LOC) in sub-Saharan Africa (SSA) and the impact of HIV infection on the risk of mortality in this population is unknown. We secondarily analyzed data from a cohort study that enrolled 359 consecutive adults with reduced LOC presenting to Mbarara Regional Hospital in Uganda with the aim of comparing the prognostic utility of the Full Outline of Unresponsiveness (FOUR) score to the Glasgow Coma Scale (GCS) Score. For this analysis, we included 336 individuals with known HIV serostatus, obtaining clinical, laboratory, and follow-up data. We recorded investigations and treatments deemed critical by clinicians for patient care but were unavailable. We computed mortality rates and used logistic regression to determine predictors of 30-day mortality. The median GCS was 10. Persons living with HIV infection (PLWH) accounted for 97 of 336 (29%) of the cohort. The 30-day mortality rate in the total cohort was 148 of 329 (45%), and this was significantly higher in PLWH (57% versus 40%, adjusted odds ratio [aOR] 2.39: 95% confidence interval [CI]: 1.31–4.35, P = 0.0046). Other predictors of mortality were presence of any unmet clinical need (aOR 1.72; 95% CIL 1.04–2.84, P = 0.0346), anemia (aOR 1.68; 95% CI: 1.01–2.81, P = 0.047), and admission FOUR score < 12 [aOR 4.26; 95% CI: 2.36–7.7, P < 0.0001). Presentation with reduced LOC in Uganda is associated with high mortality rates, with worse outcomes in PLWH. Improvement of existing acute care services is likely to improve outcomes.

Association of the Verbal Component of the GCS With Mortality in Patients With Encephalopathy Who Are Not Undergoing Mechanical Ventilation.

The utility of the Glasgow Coma Scale (GCS) in intubated patients is limited due to reliance on language function evaluation. The Full Outline of Unresponsiveness (FOUR) Score was designed to circumvent this shortcoming, instead adding evaluations of brainstem reflexes (FOUR B) and specific respiratory patterns (FOUR R). We aimed to determine whether the verbal component of the GCS (GCS V) among nonintubated patients with encephalopathy significantly contributes to mortality prediction and to assess GCS vs FOUR Score performance. All prospectively consented patients ≥18 years of age admitted to the Internal Medicine service at Zambia's University Teaching Hospital from October 3, 2017, to May 21, 2018, with a GCS score ≤10 have undergone simultaneous GCS and FOUR Score assessments. The patients were not eligible for mechanical ventilatory support per local standards. Patients' demographics and clinical characteristics were presented as either percentage frequencies or numerical summaries of spread. The predictive power of the GCS without the Verbal component vs total GCS vs FOUR Score on mortality was estimated with the area under the receiver operating characteristic curve (AU ROC). Two hundred thirty-five patients (50% women, mean age 47.5 years) were enrolled. All patients were Black. Presumed etiology was CNS infection (64, 27%), stroke (63, 27%), systemic infection (39, 16.6%), and metabolic encephalopathy (3, 14.5%); 14.9% had unknown etiology. In-hospital mortality was 83%. AU ROC for GCS Eye + Motor score (0.662) vs total GCS score (0.641) vs total FOUR Score (0.657) did not differ. Odds ratio mortality for GCS score >6 vs ≤6 was 0.32 (95% confidence interval [CI] 0.14-0.72, p = 0.01); for FOUR Score >10 vs ≤10, it was 0.41 (95% CI 0.19-0.86, p = 0.02). Absence of a verbal component of GCS had no significant impact on the performance of the total GCS, and either GCS or FOUR Score is an acceptable scoring tool for mortality prediction in the resource-limited setting. These findings need further validation in the countries with readily available mechanical ventilatory support. This study provides Class I evidence that the verbal component of the GCS does not significantly contribute to a total GCS score in mortality prediction among patients with encephalopathy who are not intubated.

Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients.

Patients With Suicidal Patterns in the Emergency Room: A Clinical and Social Reflection.

Background and objectiveEmergency physicians come across a myriad of medical afflictions resulting from suicide attempts. The Indian contribution to global suicide deaths is alarming; the social construct of India is unique, and so are the problems and challenges. This study aims to describe the social background, demographic parameters and correlate the clinical profile and outcomes of all patients presenting with an attempted or completed suicide.Materials and methodsThe present study is a hospital-based prospective observational study conducted by the Department of Emergency Medicine at RL Jalappa Hospital and Research Centre, a rural tertiary-care center in Karnataka, India, from June 2020 to February 2021. After stabilizing the patient, a detailed socio-demographic history was recorded. Details of the suicide attempt and findings of the clinical examination were noted.ResultsThe final study sample consisted of 89 patients who presented to the emergency room (ER). Fifty-three patients were female, and thirty-six were males; the average age of the sample was 28.4 ± 11 years. A higher proportion of men who completed pre-university education (p= 0.0005, c2= 11.98) or had a graduate degree (p= 0.009, c2= 6.71) attempted suicide. Amongst all women who attempted suicide, 73.6% (n=39) were married at the time of the event (p= 0.0006, c2= 11.79). Poisoning (n=59) was the most common method of attempting suicide. We also observed that it was primarily men who attempted suicide when under the influence of alcohol (p= 0.006, c2= 7.57). The most common reason for attempting suicide was familial disharmony, including domestic violence. A Glasgow Coma Scale (GCS) score of 9/15 and less at the time of presentation resulted in a mortality rate of 28.6%, whereas patients with a GCS score of 10 and above had a mortality rate of 6.1% (p= 0.04, c2= 4.14).DiscussionMarriage appears to be less protective for Indian women than Indian men. Poisoning was the most common method of attempted suicide in our study, followed by tablet overdose. The reason for the above could be ease of access to household poisons. Insecticides have been a preferred method in the Indian population over the years. Aluminum phosphide poisoning, a common constituent of rodenticides, is associated with a high mortality rate. However, in the West, firearm-related incidents have the highest mortality. Multiple correspondence analysis (MCA) of the National Crime Records Bureau (NCRB), India, data showed that adult males succumb majorly to romantic relations, unemployment, and failure in examinations. The use of alcohol was more in the illiterate and unskilled workers; however, high school educated persons and students used alcohol intentionally to facilitate suicide. Lower Glasgow Coma Scale values are associated with higher fatality; however, some studies found that Full Outline of Unresponsiveness (FOUR) and Acute Physiology and Chronic Health Evaluation Score (APACHE) II scores are better mortality indicators.ConclusionBesides the presentation and GCS score, cognizance of the lethality of different methods in attempting suicide provides clues in anticipating the patient's clinical course. The social patterns of suicide must be considered while designing awareness campaigns and focused outreach programs to decrease suicides. A strict policy must be made and enforced to limit the availability of household poisons.

Comparision of four score, GCS and GCS-P in predicting outcome at discharge in patients with acute stroke

Stroke is the second most common cause of death and adult disability. The Glasgow Coma Scale (GCS) is the most commonly used scale, and full Outline of Unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS. Our aim is to evaluate FOUR scores, GCS-P and GCS in predicting outcomes in patients with acute stroke.

Cross-Cultural Adaptation and Validation of the Greek Version of the "Full Outline of UnresponsivenessScore": A Prospective Observational Clinimetric Study in Neurosurgical Patients.

BackgroundThe Full Outline of Unresponsiveness (FOUR) score is a clinical instrument for the assessment of consciousness which is gradually gaining ground in clinical practice, as it incorporates more complete neurological information than the Glasgow Coma Scale (GCS). The main objectives of the current study were the following: (1) translate and cross-culturally adapt the FOUR score into Greek; (2) evaluate its clinimetric properties, including interrater reliability, internal consistency, and construct validity; and (3) evaluate the reliability of assessments among health care professionals with different levels of experience and training.MethodsThe FOUR score was initially translated into Greek. Next, patients with neurosurgical pathologies in need of consciousness monitoring were independently assessed with the GCS and FOUR score within one hour by four raters who had different levels of experience and training (two board-certified neurosurgeons, a neurosurgery resident, and a registered nurse). Interrater reliability, internal consistency, and construct validity were evaluated for the scales using weighted Cohen’s κ (κw) and intraclass correlation coefficients (ICC), Cronbach’s α and Spearman’s ρ values, respectively.ResultsA total of 408 assessments were performed for 99 patients. The interrater reliability was excellent for both the FOUR score (ICC = 0.941) and GCS (ICC = 0.936). The values of κw exceeded 0.90 for all pairs, suggesting that the FOUR score can be reliably applied by raters with varying experience. Among the scales’ components, FOUR score’s brainstem and respiratory items showed the lowest, yet high enough (κw > 0.60), level of agreement. The interrater reliability remained excellent (κw > 0.85, ICC > 0.90) for all diagnosis and age groups, with a trend toward higher FOUR score values in the most severe cases (ICC = 0.813 vs. 0.723). Both the FOUR score and GCS showed high internal consistency (Cronbach’s α > 0.70 for all occasions). The FOUR score correlated strongly with GCS (Spearman’s ρ > 0.90 for all raters), suggesting high construct validity.ConclusionsThe Greek version of the FOUR score is a valid and reliable tool for the clinical assessment of patients with disorders of consciousness. It can be applied successfully by nurses, residents, and specialized physicians. Therefore, its use by medical practitioners with different levels of experience and training is strongly encouraged.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12028-021-01342-w.

Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring.

The high mortality rate of comatose patients with traumatic brain injury is a prominent public health issue that negatively impacts patients and their families. Objective, reliable tools are needed to guide treatment decisions and prioritize resources. This study aimed to evaluate the prognostic value of the bispectral index (BIS) in comatose patients with severe brain injury. This was a retrospective cohort study of 84 patients with severe brain injury and Glasgow Coma Scale (GCS) scores of 8 and less treated from January 2015 to June 2017. Sedatives were withheld at least 24 hr before BIS scoring. The BIS value, GCS scores, and Full Outline of UnResponsiveness (FOUR) were monitored hourly for 48 hr. Based on the Glasgow Outcome Scale (GOS) score, the patients were divided into poor (GOS score: 1-2) and good prognosis groups (GOS score: 3-5). The correlation between BIS and prognosis was analyzed by logistic regression, and the receiver operating characteristic curves were plotted. The mean (SD) of the BIS value: 54.63 (11.76), p = .000; and GCS score: 5.76 (1.87), p = .000, were higher in the good prognosis group than in the poor prognosis group. Lower BIS values and GCS scores were correlated with poorer prognosis. Based on the area under the curve of receiver operating characteristic curves, the optimal diagnostic cutoff value of the BIS was 43.6, and the associated sensitivity and specificity were 85.4% and 74.4%, respectively. Taken together, our study indicates that BIS had good predictive value on prognosis. These findings suggested that BIS could be used to evaluate the severity and prognosis of severe brain injury.

Comparison of the Turkish versions of the Glasgow coma scale and four score used by intensive care nurses for neurological evaluation.

This study aimed to compare the use of the Turkish versions of the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) Score by intensive care nurses in neurological evaluation. This cross-sectional study was conducted between July 2018 and March 2019 with 92 patients in the general intensive care unit (ICU) of the training and research hospital of a private university. Data were collected using nurse and patient information forms, the GCS and the FOUR Score. The patients were evaluated by 27 intensive care nurses. To evaluate interrater reliability of the GCS and FOUR Score, each patient in the study was evaluated using both scales by two nurses who were blinded to each other's responses. Comparison of the patients' mean GCS and FOUR Score values from the two nurses revealed no significant difference in subscale or total scores (p>0.05). Evaluation of interrater reliability demonstrated very good agreement (κ=0.935, p<0.001). There was also very good agreement between the results of the two nurse groups when the patients' total scores were categorised according to the cut-off points for the two instruments (κ=0.927, p<0.001). This study demonstrated excellent agreement in the Turkish GCS and FOUR Score values, indicating that both scales can be used in neurological evaluation. Both instruments are reliable and easily applied by ICU nurses. The Turkish versions of the FOUR Score and GCS are both appropriate for use in intensive care units and are reliable tools for use by intensive care unit nurses.

Combination of neuron-specific enolase measurement and initial neurological examination for the prediction of neurological outcomes after cardiac arrest

This study aimed to investigate the efficacy of the combination of neuron-specific enolase (NSE) measurement and initial neurological examination in predicting the neurological outcomes of patients with cardiac arrest (CA) by retrospectively analyzing data from the Korean Hypothermia Network prospective registry. NSE levels were recorded at 48 and 72 h after CA. The initial Full Outline of UnResponsiveness (FOUR) and Glasgow Coma Scale (GCS) scores were recorded. These variables were categorized using the scorecard method. The primary endpoint was poor neurological outcomes at 6 months. Of the 475 patients, 171 (36%) had good neurological outcomes at 6 months. The areas under the curve (AUCs) of the categorized NSE levels at 72 h, GCS score, and FOUR score were 0.889, 0.722, and 0.779, respectively. The AUCs of the combinations of categorized NSE levels at 72 h with categorized GCS scores and FOUR score were 0.910 and 0.912, respectively. Each combination was significantly higher than the AUC value of the categorized NSE level at 72 h alone (with GCS: p = 0.015; with FOUR: p = 0.026). Combining NSE measurement and initial neurological examination improved the prediction of neurological outcomes.

Prognostic Utility of Daily Changes in Glasgow Coma Scale and the Full Outline of Unresponsiveness Score Measurement in Patients with Metabolic Encephalopathy, Central Nervous System Infections and Stroke in Uganda.

Metabolic encephalopathy (ME), central nervous system (CNS) infections, and stroke are common causes of reduced level of consciousness in Uganda. However, the prognostic utility of changes in the daily measurements of the Full Outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) score in these specific disorders is not known. We conducted secondary analyses of data from patients who presented with reduced level of consciousness due to CNS infections, stroke, or ME to a tertiary hospital in Uganda. Patients had FOUR/GCS scores at admission and at 24 and 48h. We calculated a change in FOUR score (ΔFOUR) and change in GCS score (ΔGCS) at 24 and 48h and used logistic regression models to determine whether these changes were predictive of 30-day mortality. In addition, we determined the prognostic utility of adding the admission score to the 24-h ΔFOUR and 24-h ΔGCS on mortality. We analyzed data from 230 patients (86 with ME, 79 with CNS infections, and 65 with stroke). The mean (SD) age was 50.8 (21.3) years, 27% (61 of 230) had HIV infection, and 62% (134 of 230) were peasant farmers. ΔFOUR at 24h was predictive of mortality among those with ME (odds ratio [OR] 0.64 [95% confidence interval {CI} 0.48-0.84]; p = 0.001) and those with CNS infections (OR 0.65 [95% CI 0.48-0.87]; p = 0.004) but not in those with stroke (OR 1.0 [95% CI 0.73-1.38]; p = 0.998). However, ΔGCS at 24h was only predictive of mortality in the ME group (OR 0.69 [95% CI 0.56-0.86]; p = 0.001) and not in the CNS or stroke group. This 24-h ΔGCS and ΔFOUR pattern was similar at 48h in all subgroups. The addition of an admission score to either 24-h ΔFOUR or 24-h ΔGCS significantly improved the predictive ability of the scores in those with stroke and CNS infection but not in those with ME. Twenty-four-hour and 48-h ΔFOUR and ΔGCS are predictive of mortality in Ugandan patients with CNS infections and ME but not in those with stroke. For individuals with stroke, the admission score plays a more significant predictive role that the change in scores.

Comparison of the Full Outline of Unresponsiveness Score with the Glasgow Coma Scale as a Coma Assessment Scale in Pediatric Intensive Care

AbstractRapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

Effect of training sessions about Full Outline of Un-Responsiveness scale compared to Glasgow Coma Scale on nurses’ performance, perception and its reliability

Background: Assessing patients’ level of consciousness in intensive care units (ICUs) through Full Outline of Un-Responsiveness (FOUR) scale versus the Glasgow Coma Scale (GCS) requires critical care nurses’ (CCNs) knowledge and skills to detect deterioration of patients’ level of consciousness. Objectives: To evaluate the effect of implementing training sessions on critical care nurses’ performance and perception regarding FOUR scale compared to GCS and reliability of each one. Research hypotheses: Nurses who attend training sessions will show a significant improvement in performance of FOUR scale compared to GCS. Study design: A pretest posttest study design was used in this study. Method: The study was conducted at seven ICUs at Alexandria Main University Hospital including; Unit I, Unit II, Unit III, Medical, Respiratory, Neurosurgery, and Emergency anesthesia ICUs. Subject: A convenient sampling technique of all CCNs (100) and a purposive sample of adult critically ill patients equivalent to the number of nurses’ sample was used to recruit the participants from previously mentioned CCUs. Results: The implemented training sessions were significantly effective in increasing CCNs’ performance and positive perception of FOUR scale compared to GCS. There was overall higher inter-rater reliability regarding FOUR score than that of GCS score Cohen’s kappa (0.92 versus 0.81) and 83% of nurses agreed that FOUR scale is a preferred scale to assess the depth of coma. Conclusion: training sessions were significantly effective in increasing CCNs’ performance and positive perception regarding FOUR scale compared to GCS. Recommendation: Nursing administrators should provide continuous training sessions. Manual for procedures is advised to be distributed to all CCNs including all methods for assessing patients’ level of consciousness (LOC).

Forecast of the medical evacuation in patients with the cardiovascular dysfunction. A retrospective study

Introduction. The prognosis for the patients with the cardiovascular dysfunction and the use vasopressors or cardiotonics is always doubtful. Frequently patientʼs unstability and usage of vasoactive drugs increases the risks of incidents and are contraindication for medical evacuation. The results of published studies indicate that the use of these drugs when transporting patients is accompanied by certain risks, and methods for their prediction are not well described. Objectives. Determine prognostic factors and evaluate the results of medical evacuation in patients requiring vasopressor and cardiotonic support. Materials and methods. The retrospective study included 1210 patients from the database of the Tyumenʼs resuscitative-consultative center and the prospective study included 41 patients who were delivered to the Tyumen level III hospitals in 2019. Patients were distributed into 2 groups — survivors and deceased after evacuation. Results. Our study showed the importance of the integral estimation of severity of patients subjected to medical evacuation and the high predictive value of the National Early Warning Score (NEWS) scale and Full Outline of UnResponsiveness (FOUR) at the stages of evacuation. In the next day after delivery, the Acute Physiology And Chronic Health Evaluation (APACHE II) scale demonstrated high prediction accuracy. Despite the risks associated with the development of undesirable situations during transportation (their frequency according to our data was 12.2 %), the evacuation of patients with cardiovascular dysfunction increases the chance of an favorable outcome 2.8 time. Conclusions. Despite the presence of vascular dysfunction, the evacuation of patients in need of vasopressor and cardiotonic support is a life-saving measure that increases the chances of patients for a favorable outcome by 2.82 times.

Study to assess the effectiveness of structured teaching programme on knowledge regarding four score (full outline of unresponsiveness) coma scale among Staff nurses working in intensive care units in selected Hospitals

Study to assess the effectiveness of structured teaching programme on knowledge regarding four score (full outline of unresponsiveness) coma scale among Staff nurses working in intensive care units in selected Hospitals

Quality of models of scales of consciousness level, functional state, and General somatic severity in patients with consequences of brain damage in intensive care and rehabilitation department.

Aims: development and substantiation of a typical scheme for the clinical use of scales of the level of consciousness, general somatic and functional status of patients with of brain damage. Methods: Included 118 patients on 20-50 days after traumatic brain injury, anoxic damage; consequences of acute cerebral circulatory disorders, and neurosurgical operations. In groups of patients who are in a coma, vegetative status, a state of minimal consciousness and a state of clear consciousness, the analysis of the statistical quality of clinical scales was carried out: scales of consciousness: the Glasgow coma Scale (GCS); FOUR (Full Outline of UnResponsiveness); CRS-R-Coma Recovery Scale-Revised; the Glasgow outcome Scale (COS); the extended scale of the Glasgow coma (COSE - Glasgow outcome scale extended); Rancho Los Amigos scale-scale of consciousness and interaction with the environment (the Rancho Los Amigos scale - RLAS); Functional status scales: DRS (the Disability Rating Scale); modified Rankin Scale mRS; Barthel Activities of Daily Living (ADL) Index; functional independence measure-FIM; Karnovsky Index; Rivermead Mobility Index self-assessment of everyday life opportunities in Merton and Sutton (checklist self-maintenance. Merton and Sutton community NHS trust); Scales of General somatic severity: assessment of multi-organ dysfunction on the APACHE II scale (Acute Physiology and Chronic Health Evaluation); APACHE IV scale; SAPS II scale (Simplified Acute Physiology Score); SOFA scale (Sequential Organ Failure Assessment). The functional state of the ANS was recorded using HRV parameters by recording 5-minute RR intervals of the electrocardiogram. Results: There are 4 groups of patients who are in a state of coma, vegetative status, a state of minimal consciousness and a state of clear consciousness. In 67 patients out of 118 examined (56.8%) the parameters of ANS functional activity are in the zone of pathological (sympathetic/parasympathetic hyperactivity) values. Conclusions: Various scales of the level of consciousness, functional and general somatic severity of patients objectively differ in clinical significance in the gradation of coma - vegetative status - minimal consciousness - clear consciousness.

Можливості клініко-нейровізуалізаційної верифікації прогнозу перебігу гострого періоду спонтанного супратенторіального внутрішньомозкового крововиливу на тлі консервативної терапії

The aim of the study – to improve the diagnostic measures in patients with spontaneous supratentorial intracerebral hemorrhage through elaboration of the prognostic criteria for the early neurological deterioration on the ground of comparative analysis of clinical scales that evaluate the severity of patient’s condition. Materials and methods. Prospective, cohort investigation of 339 patients (mean age 64,8±0,6 years) in acute period of spontaneous supratentorial intracerebral hemorrhage was done. The diagnosis was made on the ground of clinical, neurovisualization examination. Initial patient’s condition severity was estimated by using the National Institute of Health Stroke Scale (NIHSS), Full Outline of UnResponsiveness (FOUR) Scale, Glasgow Coma Scale, original Intracerebral Hemorrhage Scale (oICH), modified Intracerebral Hemorrhage Scales (mICH-A, mICH-B), Intracerebral Hemorrhage Grading Scale (ICH-GS), Intracerebral Hemorrhage Functional Outcome Scale (ICH-FOS). The early neurological deterioration was used as a cumulative end-point. It was detected as onset of one or some events from the following during 24 hours from the admission on the ground of conservative therapy: 1) decrease of FOUR score ≥2; 2) increase of NIHSS score ≥4; 3) lethal outcome. Logistic regression and ROC-analysis were used for prognostic criteria elaboration. Results. Clinical neurological deterioration during 24 hours from admission was revealed in 99 (29,2%) patients. On the ground of univariate logistic regression analysis it was detected that the risk of early neurological deterioration in patients with spontaneous supratentorial intracerebral hemorrhage on the ground of conservative therapy is evaluated as the following summary score: oICH (OR (95% CІ) = 2,71 (2,07–3,55), р˂0,0001), mICH-A (OR (95% CІ) = 1,70 (1,50–1,93), р˂0,0001), mICH-B (OR (95% CІ) = 1,81 (1,57–2,09), р˂0,0001), ICH-GS (OR (95% CІ) = 1,91 (1,59–2,29), р˂0,0001) and ICH-FOS (OR (95% CI) = 1,40 (1,28–1,54), р˂0,0001). It was detected that mICH-A and mICH-B scales differ with higher AUC values compared with oICH, ICH-GS and ICH-FOS concerning early neurological deterioration prediction in patients with spontaneous supratentorial intracerebral hemorrhage. Conclusions. Early neurological deterioration predictors in patients with spontaneous supratentorial intracerebral hemorrhage during 24 hours from the admission are the mICH-A score &gt;4 (sensitivity = 71,7%, specificity = 78,8%) and mICH-B score &gt;2 (sensitivity = 82,8%, specificity = 63,8%)

Brain Injury in Critical Illness and a Note on the Virus

Brain Injury in Critical Illness and a Note on the Virus