nach oben

Neurocritical Care

Erschienen in:

01.12.2014 | Original Article

The FOUR Score Predicts Mortality, Endotracheal Intubation and ICU Length of Stay After Traumatic Brain Injury

verfasst von: Ahmed Said Okasha, Akram Muhammad Fayed, Ahmad Sabry Saleh

Erschienen in: Neurocritical Care | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

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 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 (r ² = 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.

Nur mit Berechtigung zugänglich

World Health Organization. Traumatic brain injuries. In: Neurological disorders: public health challenges. Geneva: World Health Organization; 2006. p. 164–75.

Lingsma HF, Roozenbeek B, Steyerberg EW, Murray GD, Maas AI. Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol. 2010;9:543–54.PubMedCrossRef

Matis G, Birbilis T. The Glasgow Coma Scale—a brief review. Past, present, future. Acta Neurol Belg. 2008;108:75–89.PubMed

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9.PubMedCrossRef

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.PubMedCrossRef

Champion HR, Copes WS, Sacco WJ, et al. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation. J Trauma. 1996;40:42–8.PubMedCrossRef

Perel P, Edwards P, Wentz R, Roberts I. Systematic review of prognostic models in traumatic brain injury. BMC Med Inform Decis Mak. 2006;6:38.PubMedCentralPubMedCrossRef

Perel P, Arango M, Clayton T, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336:425–9.PubMedCrossRef

Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5:e165.PubMedCentralPubMedCrossRef

10.

Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.PubMedCrossRef

11.

Fischer M, Rüegg S, Czaplinski A, et al. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care. 2010;14:R64.PubMedCentralPubMedCrossRef

12.

Idrovo L, Fuentes B, Medina J, et al. Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study. Eur Neurol. 2010;63:364–9.PubMedCrossRef

13.

Kramer AA, Wijdicks EF, Snavely VL, et al. A multicenter prospective study of interobserver agreement using the Full Outline of Unresponsiveness score coma scale in the intensive care unit. Crit Care Med. 2012;40:2671–6.PubMedCrossRef

14.

Marcati E, Ricci S, Casalena A, Toni D, Carolei A, Sacco S. Validation of the Italian version of a new coma scale: the FOUR score. Intern Emerg Med. 2012;7:145–52.PubMedCrossRef

15.

Menon DK, Schwab K, Wright DW, Maas AI. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91:1637–40.PubMedCrossRef

16.

Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.PubMedCrossRef

17.

Marshall LF, Marshall SB, Klauber MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma. 1992;9:S287–92.PubMed

18.

Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma. 1998;15:587–97.PubMedCrossRef

19.

Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40.PubMedCrossRef

20.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.PubMedCrossRef

21.

Qualls M, Pallin DJ, Schuur JD. Parametric versus nonparametric statistical tests: the length of stay example. Acad Emerg Med. 2010;17:1113–21.PubMedCrossRef

22.

Hyam JA, Welch CA, Harrison DA, Menon DK. Case mix, outcomes and comparison of risk prediction models for admissions to adult, general and specialist critical care units for head injury: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care. 2006;10:S2.PubMedCentralPubMedCrossRef

23.

Hoffmann M, Lefering R, Rueger JM, et al. Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. Br J Surg. 2012;99:122–30.PubMedCrossRef

24.

Vivien B, Yeguiayan JM, Le Manach Y, et al. The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients. Am J Emerg Med. 2012;30:1032–41.PubMedCrossRef

25.

Sadaka F, Patel D, Lakshmanan R. The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care. 2012;16:95–101.PubMedCrossRef

26.

McNett M, Amato S, Gianakis A, et al. The FOUR Score and GCS as predictors of outcome after traumatic brain injury. Neurocrit Care. 2014 Jan 10 [Epub ahead of print]. doi:10.1007/s12028-013-9947-6.

27.

Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9:231–6.PubMedCrossRef

28.

Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24:270–80.PubMedCrossRef

29.

Chamoun RB, Robertson CS, Gopinath SP. Outcome in patients with blunt head trauma and a Glasgow Coma Scale score of 3 at presentation. J Neurosurg. 2009;111:683–7.PubMedCentralPubMedCrossRef

30.

Demetriades D, Kuncir E, Velmahos GC, Rhee P, Alo K, Chan LS. Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3. Arch Surg. 2004;139:1066–8.PubMedCrossRef

31.

Chen B, Grothe C, Schaller K. Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness. Acta Neurochir (Wien). 2013;155:2133–9.PubMedCrossRef

32.

Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet. 1996;348:123–4.PubMedCrossRef

33.

Frontera JA, de los Reyes K, Gordon E, et al. Trend in outcome and financial impact of subdural hemorrhage. Neurocrit Care. 2011;14:260–6.PubMedCrossRef

34.

Kim YJ. The impact of time from ED arrival to surgery on mortality and hospital length of stay in patients with traumatic brain injury. J Emerg Nurs. 2011;37:328–32.PubMedCrossRef

35.

Knaus WA, Wagner DP, Zimmerman JE, Draper EA. Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993;118:753–61.PubMedCrossRef

36.

Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G. Factors influencing length of stay in the intensive care unit. Am J Crit Care. 2006;15:502–9.PubMed

37.

Singh B, Murad MH, Prokop LJ, et al. Meta-analysis of Glasgow coma scale and simplified motor score in predicting traumatic brain injury outcomes. Brain Inj. 2013;27:293–300.PubMedCrossRef

38.

Wisborg T, Montshiwa TR, Mock C. Trauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival. Scand J Trauma Resusc Emerg Med. 2011;19:62.PubMedCentralPubMedCrossRef

39.

Sitsapesan HA, Lawrence TP, Sweasey C, Wester K. Neurotrauma outside the high-income setting: a review of audit and data-collection strategies. World Neurosurg. 2013;79:568–75.PubMedCrossRef

40.

Agrawal D, Joshua SP, Gupta D, Sinha S, Satyarthee GD. Can glasgow score at discharge represent final outcome in severe head injury? J Emerg Trauma Shock. 2012;5:217–9.PubMedCentralPubMedCrossRef

Titel: The FOUR Score Predicts Mortality, Endotracheal Intubation and ICU Length of Stay After Traumatic Brain Injury
verfasst von: Ahmed Said Okasha
Akram Muhammad Fayed
Ahmad Sabry Saleh
Publikationsdatum: 01.12.2014
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 3/2014
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-014-9995-6

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2014

Intraventricular Fibrinolysis has No Effects on Shunt Dependency and Functional Outcome in Endovascular-Treated Aneurysmal SAH

A Comparative Study of Fractional Anisotropy Measures and ICH Score in Predicting Functional Outcomes After Intracerebral Hemorrhage

High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias

Simulation-Based Training in Brain Death Determination

Brain Death Determination: Still a Lot to Learn, Still a Lot to Do…