Acute Crit Care.  2023 May;38(2):226-233. 10.4266/acc.2023.00570.

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India

• Agrawal N
• Iyer SS
• Patil V
• Kulkarni S
• Shah JN
• Jedge P

• KMID: 2543642
• DOI: http://doi.org/10.4266/acc.2023.00570

Abstract

Background
This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods: We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson’s correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. Results: In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. Conclusions: The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Keyword

FOUR score; Glasgow Coma Scale; Glasgow Coma Scale Pupil; Glasgow Outcome Scale; traumatic brain injury

Figure

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  Figure 1. The flowchart of the study. TBI: traumatic brain injury.

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  Figure 2. Receiver operating characteristic curve of Glasgow Coma Scale (GCS), Glasgow Coma Scale Pupil (GCS-P), Full Outline of Unresponsiveness (FOUR) scores, and number of computed tomography (CT) abnormalities.

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