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FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury

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Abstract

Background

The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients.

Methods

From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled. Three advanced practice nurses administered the FOUR score, GCS, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Therapeutic Intervention Scoring System (TISS) concurrently from ICU admissions. The endpoint of observation was mortality when the patients left the ICU. Data are presented as frequency with percentages, mean with standard deviation, or median with interquartile range. Each measurement tool used area under the receiver operating characteristic curve to compare the predictive power between these four tools. In addition, the difference between survival and death was estimated using the Wilcoxon rank sum test.

Results

From 55 TBI patients, males (72.73 %) were represented more than females, the mean age was 63.1 ± 17.9, and 19 of 55 observations (35 %) had a maximum FOUR score of 16. The overall mortality rate was 14.6 %. The area under the receiver operating characteristic curve was 74.47 % for the FOUR score, 74.73 % for the GCS, 81.78 % for the APACHE II, and 53.32 % for the TISS. The FOUR score has similar predictive power of mortality compared to the GCS and APACHE II. Each of the parameters—E, M, B, and R—of the FOUR score showed a significant difference between mortality and survival group, while the verbal and eye-opening components of the GCS did not.

Conclusion

Having similar predictive power of mortality compared to the GCS and APACHE II, the FOUR score can be used as an alternative in the prediction of early mortality in TBI patients in the ICU.

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Acknowledgments

Research has been funded by CMHCR10401 grants.

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Authors and Affiliations

  1. Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan

    Tee-Tau Eric Nyam, Kam-Hou Ao & Jinn-Rung Kuo

  2. Department of Nursing, Chi-Mei Medical Center, Tainan, Taiwan

    Shu-Yu Hung, Mei-Li Shen & Tzu-Chieh Yu

  3. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Jinn-Rung Kuo

Authors
  1. Tee-Tau Eric Nyam
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  2. Kam-Hou Ao
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  3. Shu-Yu Hung
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  4. Mei-Li Shen
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  5. Tzu-Chieh Yu
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  6. Jinn-Rung Kuo
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Correspondence to Jinn-Rung Kuo.

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Nyam, TT.E., Ao, KH., Hung, SY. et al. FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury. Neurocrit Care 26, 225–231 (2017). https://doi.org/10.1007/s12028-016-0326-y

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  • DOI: https://doi.org/10.1007/s12028-016-0326-y

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