Comparison of the Full Outline of Unresponsiveness Score with the Glasgow Coma Scale as a Coma Assessment Scale in Pediatric Intensive Care

Abstract

Rapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

Keywords

impairment of consciousness - glasgow coma scale - full outline of unresponsiveness score - pediatric intensive care

Conclusion

In pediatric intensive care units, monitoring the level of consciousness is an important factor in predicting the clinical course and outcome. As a coma assessment scale, the FOUR score is a good predictor of mortality, need for mechanical ventilation, and brain death, similar to GCS.

Publikationsverlauf

Eingereicht: 29. Dezember 2020

Angenommen: 22. Februar 2021

Artikel online veröffentlicht:
13. April 2021

• References

• 1 Chen B, Grothe C, Schaller K. Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness. Acta Neurochir (Wien) 2013; 155 (11) 2133-2139 , discussion 2139
• 2 Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014; 13 (08) 844-854
• 3 Reith FCM, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AIR. Differential effects of the Glasgow Coma Scale Score and its components: an analysis of 54,069 patients with traumatic brain injury. Injury 2017; 48 (09) 1932-1943
• 4 Kasprowicz M, Burzynska M, Melcer T, Kübler A. A comparison of the Full Outline of UnResponsiveness (FOUR) score and Glasgow Coma Score (GCS) in predictive modelling in traumatic brain injury. Br J Neurosurg 2016; 30 (02) 211-220
• 5 Wijdicks EFM, Rabinstein AA, Bamlet WR, Mandrekar JN. FOUR score and Glasgow Coma Scale in predicting outcome of comatose patients: a pooled analysis. Neurology 2011; 77 (01) 84-85
• 6 Garcia PC, Piva JP. Pediatric index of mortality 2 (PIM2)—a prognostic tool for developing countries: easy, efficient, and free!. Pediatr Crit Care Med 2007; 8 (01) 77-78
• 7 Pollack MM, Holubkov R, Funai T. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. The Pediatric Risk of Mortality Score: update 2015. Pediatr Crit Care Med 2016; 17 (01) 2-9
• 8 Leteurtre S, Martinot A, Duhamel A. et al. Development of a pediatric multiple organ dysfunction score: use of two strategies. Med Decis Making 1999; 19 (04) 399-410
• 9 Khajeh A, Fayyazi A, Miri-Aliabad G, Askari H, Noori N, Khajeh B. Comparison between the ability of Glasgow Coma Scale and Full Outline of Unresponsiveness Score to predict the mortality and discharge rate of pediatric intensive care unit patients. Iran J Pediatr 2014; 24 (05) 603-608
• 10 Kirkham FJ, Newton CRJC, Whitehouse W. Paediatric coma scales. Dev Med Child Neurol 2008; 50 (04) 267-274
• 11 Sadaka F, Patel D, Lakshmanan R. The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care 2012; 16 (01) 95-101
• 12 Büyükcam F, Kaya U, Karakılıç ME, Cavuş UY, Turan Sönmez F, Odabaş O. Predicting the outcome in children with head trauma: comparison of FOUR score and Glasgow Coma Scale. Ulus Travma Acil Cerrahi Derg 2012; 18 (06) 469-473
• 13 Sahin AS, Sahin M, Kavrut Ozturk N, Kizilates E. KarslÄś B Comparison of GCS and FOUR scores used in the evaluation of neurological status in intensive care units. J Contemp Med 2015; 5: 167-172
• 14 Anestis DM, Tsitsopoulos PP, Tsonidis CA, Foroglou N. The current significance of the FOUR score: a systematic review and critical analysis of the literature. J Neurol Sci 2020; 409: 116600
• 15 Khanal K, Bhandari SS, Shrestha N, Acharya SP, Marhatta MN. Comparison of outcome predictions by the Glasgow coma scale and the Full Outline of UnResponsiveness score in the neurological and neurosurgical patients in the Intensive Care Unit. Indian J Crit Care Med 2016; 20 (08) 473-476
• 16 Bayraktar YS, Sahinoglu M, Cicekci F. et al. Comparison of Glasgow Coma Scale and Full Outline of Unresponsiveness (Four) Score: a prospective study. Turk Neurosurg 2019; 29 (02) 285-288
• 17 Sucu A, Tolunay O, Celik T. et al. Evaluation of patients diagnosed with brain death in pediatric critical care. J Pediatr Emerg Intensive Care Med 2018; 5: 59-63
• 18 Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005; 58 (04) 585-593
• 19 Orken ND, Sagduyu AK, Sırın H. et al. Reliability of the Turkish version of a new coma scale: FOUR score. Med J Trakya Univ 2010; 27: 28-31
• 20 Ramazani J, Hosseini M. Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in medical intensive care unit. Ann Card Anaesth 2019; 22 (02) 143-148
• 21 Momenyan S, Mousavi SM, Dadkhahtehrani T. et al. Predictive validity and inter-rater reliability of the Persian Version of Full Outline of Unresponsiveness among unconscious patients with traumatic brain injury in an intensive care unit. Neurocrit Care 2017; 27 (02) 229-236
• 22 Ramazani J, Hosseini M. Prediction of ICU mortality in critically ill children: comparison of SOFA, GCS, and FOUR score. Med Klin Intensivmed Notf Med 2019; 114 (08) 717-723
• 23 Baratloo A, Shokravi M, Safari S, Aziz AK. Predictive value of Glasgow coma score and full outline of unresponsiveness score on the outcome of multiple trauma patients. Arch Iran Med 2016; 19 (03) 215-220