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Neurocritical Care

, Volume 16, Issue 1, pp 95–101 | Cite as

The FOUR Score Predicts Outcome in Patients After Traumatic Brain Injury

  • Farid SadakaEmail author
  • Darshan Patel
  • Rekha Lakshmanan
Original Article

Abstract

Background

The most widely used and most studied coma score to date is the Glasgow Coma Scale (GCS), which is used worldwide to assess level of consciousness and predict outcome after traumatic brain injury (TBI). Our aim was to determine whether the Full Outline of UnResponsiveness (FOUR) score is an accurate predictor of outcome in TBI patients and to compare its performance to GCS.

Methods

We prospectively identified TBI patients admitted to our Neuro-ICU between July 2010 and February 2011. We enrolled 51 patients. The FOUR score and GCS were determined by one of the investigators. Outcomes were in-hospital mortality, and poor neurologic outcome (Glasgow Outcome Scale (GOS) 1–3 and Modified Rankin Scale (mRS) score 3–6) at 3–6 months.

Results

There was a high degree of internal consistency for both the FOUR score (Cronbach’s alpha = 0.89) and GCS (Cronbach’s alpha = 0.85). In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic (ROC) curve was 0.93 for FOUR score and 0.89 for GCS. In terms of predictive power of poor neurologic outcome at 3–6 months, the area under the ROC curve was 0.85 for FOUR score and 0.83 for GCS as evidenced by GOS 1–3, and 0.80 for FOUR score and 0.78 for GCS as evidenced by mRS 3–6. The odds ratio (OR) for in-hospital mortality was 0.64 (0.46–0.88) from FOUR score and 0.63 (0.45–0.89) from GCS, for poor neurologic outcome was 0.67 (0.53–0.85) from FOUR score and 0.65 (0.51–0.83) from GCS for GOS, and was 0.71 (0.57–0.87) from FOUR score and 0.71 (0.57–0.87) from GCS for mRS.

Conclusion

The FOUR score is an accurate predictor of outcome in TBI patients. It has some advantages over GCS, such as all components of FOUR score but not GCS can be rated in intubated patients.

Keywords

Coma Traumatic brain injury Full Outline of UnResponsiveness (FOUR) score Glasgow coma scale 

Notes

Acknowledgments

The authors would like to acknowledge Edward Spitznagel, PhD for his statistical support.

Disclosures

This study was not sponsored. None of the authors have anything to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.St. John’s Mercy Medical CenterSt Louis UniversitySt. LouisUSA

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