The FOUR Score Predicts Mortality, Endotracheal Intubation and ICU Length of Stay After Traumatic Brain Injury
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ORIGINAL ARTICLE
The FOUR Score Predicts Mortality, Endotracheal Intubation and ICU Length of Stay After Traumatic Brain Injury Ahmed Said Okasha • Akram Muhammad Fayed Ahmad Sabry Saleh
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Ó Springer Science+Business Media New York 2014
Abstract Background The Glasgow Coma Scale (GCS) is the most widely accepted scale for assessing levels of consciousness, clinical status, as well as prognosis of traumatic brain injury (TBI) patients. The Full Outline of UnResponsiveness (FOUR) score is a new coma scale developed addressing the limitations of the GCS. The aim of this prospective cohort study was to compare the performance of the FOUR score vs. the GCS in predicting TBI outcomes. Methods From April to July 2011, 60 consecutive adult patients with TBI admitted to the Alexandria Main University Hospital intensive care units (ICU) were enrolled in the study. GCS and FOUR score were documented on arrival to emergency room. Outcomes were in-hospital mortality, unfavorable outcome [Glasgow outcome scale
This article is dedicated to the memory of the late professor Hassan Abou-Khabar, former chair of the Critical Care Medicine Department, Faculty of Medicine, Alexandria University.
Electronic supplementary material The online version of this article (doi:10.1007/s12028-014-9995-6) contains supplementary material, which is available to authorized users. A. S. Okasha Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt A. M. Fayed Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt A. S. Saleh (&) Intensive Care Unit, Kom el-Shoqafa Chest Hospital, Khufu Street, Karmoz, 21572 Alexandria, Egypt e-mail: [email protected]
extended (GOSE) 1–4], endotracheal intubation, and ICU length of stay (LOS). Results Fifteen (25 %) patients died and 35 (58 %) had unfavorable outcome. When predicting mortality, the FOUR score showed significantly higher area under receiver operating characteristic curve (AUC) than the GCS score (0.850 vs. 0.796, p = 0.025). The FOUR score and the GCS score were not different in predicting unfavorable outcome (AUC 0.813 vs. 0.779, p = 0.136) and endotracheal intubation (AUC 0.961 vs. 0.982, p = 0.06). Both scores were good predictors of ICU LOS (r2 = 0.40 [FOUR score] vs. 0.41 [GCS score]). Conclusions The FOUR score was superior to the GCS in predicting in-hospital mortality in TBI patients. There was no difference between both scores in predicting unfavorable outcome, endotracheal intubation, and ICU LOS. Keywords Traumatic brain injury Glasgow Coma Scale FOUR score Glasgow outcome score Outcome assessment Length of stay
Introduction Traumatic brain injury (TBI) is the leading cause of death and disability in young adults around the world and is involved in nearly half of all trauma deaths. Most of the victims are from the low- and middle-income countries (LMICs) [1]. Facing this public health challenge; accurate and early outcome prediction would not only facilitate clinical decisio
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