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

Neurocritical Care volume 21, pages 496–504 (2014)Cite this article

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.

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Conflict of Interest

Ahmed Said Okasha, Akram Muhammad Fayed, and Ahmad Sabry Saleh declare that they have no conflict of interest.

Funding

None.

Author information

Affiliations

  1. Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Ahmed Said Okasha

  2. Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Akram Muhammad Fayed

  3. Intensive Care Unit, Kom el-Shoqafa Chest Hospital, Khufu Street, Karmoz, 21572, Alexandria, Egypt

    Ahmad Sabry Saleh

Authors
  1. Ahmed Said Okasha
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  2. Akram Muhammad Fayed
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Corresponding author

Correspondence to Ahmad Sabry Saleh.

Additional information

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.

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Cite this article

Okasha, A.S., Fayed, A.M. & Saleh, A.S. The FOUR Score Predicts Mortality, Endotracheal Intubation and ICU Length of Stay After Traumatic Brain Injury. Neurocrit Care 21, 496–504 (2014). https://doi.org/10.1007/s12028-014-9995-6

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Keywords

  • Traumatic brain injury
  • Glasgow Coma Scale
  • FOUR score
  • Glasgow outcome score
  • Outcome assessment
  • Length of stay