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The FOUR Score and GCS as Predictors of Outcome After Traumatic Brain Injury

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Abstract

Background

The Glasgow Coma Scale (GCS) is a routine component of a neurological exam for critically ill traumatic brain injury (TBI) patients, yet has been criticized for not accurately depicting verbal status among intubated patients or including brain stem reflexes. Preliminary research on the Full Outline of UnResponsiveness (FOUR) Scale suggests it overcomes these limitations. Research is needed to determine correlations with patient outcomes. The aims of this study were to: (1) examine correlations between 24 and 72 h FOUR and GCS scores and functional/cognitive outcomes; (2) determine relationship between 24 and 72 h FOUR scores and mortality.

Methods

Prospective cohort study. Data gathered on adult TBI patients at a Level I trauma center. FOUR scores assigned at 24, 72 h. Functional outcome measured by functional independence measure scores at rehabilitation discharge; cognitive status measured by Weschler Memory Scale scores 3 months post-injury.

Results

n = 136. Mean age 53.1. 72 h FOUR and GCS scores correlated with functional outcome (r s = 0.34, p = 0.05; r s = 0.39, p = 0.02), but not cognitive status. Receiver operating characteristic curves were comparable for FOUR and GCS at 24 and 72 h for functional status (24 h FOUR, GCS = 0.625, 0.602, respectively; 72 h FOUR, GCS = 0.640, 0.688), cognitive status (24 h FOUR, GCS = 0.703, 0.731; 72 h FOUR, GCS = 0.837, 0.674), and mortality (24 h FOUR, GCS = 0.913, 0.935; 72 h FOUR, GCS = 0.837, 0.884).

Conclusions

FOUR is comparable to GCS in terms of predictive ability for functional status, cognitive outcome 3 months post-injury, and in-hospital mortality.

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Acknowledgments

This study received partial funding from Sigma Theta Tau International.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Nursing Research, The MetroHealth System, Cleveland, OH, USA

    Molly McNett

  2. Department of Nursing, The MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA

    Shelly Amato

  3. Department of Nursing, Trauma/Critical Care/Burns, The MetroHealth System, Cleveland, OH, USA

    Anastasia Gianakis & Dawn Grimm

  4. Department of Physical Medicine and Rehabilitation, The MetroHealth Rehabilitation Institute of Ohio, Case Western Reserve University, Cleveland, OH, USA

    Sue Ann Philippbar

  5. Department of Nursing, Trauma/Critical Care, The MetroHealth System, Cleveland, OH, USA

    Josie Belle & Cristina Moran

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  1. Molly McNett
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  2. Shelly Amato
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  4. Dawn Grimm
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Correspondence to Molly McNett.

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McNett, M., Amato, S., Gianakis, A. et al. The FOUR Score and GCS as Predictors of Outcome After Traumatic Brain Injury. Neurocrit Care 21, 52–57 (2014). https://doi.org/10.1007/s12028-013-9947-6

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  • DOI: https://doi.org/10.1007/s12028-013-9947-6

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