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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(01): 001-007
DOI: 10.1055/s-0044-1779515
Original Article

Comparison of the Prognostic Accuracy of Full Outline of Unresponsiveness (FOUR) Score with Glasgow Coma Scale (GCS) Score among Patients with Traumatic Brain Injury in a Tertiary Care Center

Indrani Chattopadhyay 
1   Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Lakshmi Ramamoorthy 
1   Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Manoranjitha Kumari 
2   Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
K.T. Harichandrakumar 
3   Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
H.T. Lalthanthuami 
1   Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Rani Subramaniyan 
1   Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
› Author Affiliations Funding This study was supported by JIPMER Intramural Research Fund.
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Abstract

Objectives The Glasgow Coma Scale (GCS) is widely used and considered the gold standard in assessing the consciousness of patients with traumatic brain injury. However, some significant limitations, like the considerable variations in interobserver reliability and predictive validity, were the reason for developing the Full Outline of Unresponsiveness (FOUR) score. The current study aims to compare the prognostic accuracy of the FOUR score with the GCS score for in-hospital mortality and morbidity among patients with traumatic brain injury.

Materials and Methods A prospective cohort study was conducted, where 237 participants were selected by consecutive sampling from a tertiary care center. These patients were assessed with the help of GCS and FOUR scores within 6 hours of admission, and other clinical parameters were also noted. The level of consciousness was checked every day with the help of GCS and FOUR scores until their last hospitalization day. Glasgow Outcome Scale was used to assess their outcome on the last day of hospitalization. The GCS and FOUR scores were compared, and data were analyzed by descriptive and inferential statistics. The chi-square test, independent Student's t-test, and receiver operating characteristic analysis were used for inferential analysis.

Results The area under the curve (AUC) for the GCS score at the 6th hour for predicting mortality was 0.865 with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 64%. The AUC for FOUR scores at the 6th hour for predicting the mortality was 0.893, with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 73%.

Conclusion The current study shows that, as per the AUC of GCS and FOUR scores, their sensitivity was equal, but specificity was higher in the FOUR score. So, the FOUR score has higher accuracy than the GCS score in the prediction of mortality among traumatic brain injury patients.

Keywords

traumatic brain injury - Glasgow Coma Scale - Full Outline of Unresponsiveness - sensitivity and specificity - ROC curve

Ethical Approval

Institutional Ethics Committee (JIP/CON/IEC/M.Sc./2020/MSN/5) for human studies and Nursing Research Monitoring Committee (JIP/CON/NRMC/M.Sc./2020/MSN/6) approved the study. The procedures followed were by the ethical standards of the institution as well as the Declaration of Helsinki revised in 2013. All the participants were enrolled after obtaining informed consent from legally authorized representatives of the patients. Data confidentiality, the anonymity of the subjects, and the right to withdraw from the study were explained to participants before data collection.


Data Availability Statement

The data set used in the current study is available on request from College of Nursing, JIPMER, through the corresponding author. L.R., I.C., M.K., K.T.H., H.T.L., and R,S. reported support for the present manuscript from JIPMER Intramural Research Fund (payment to primary investigator).




Publication History

Article published online:
16 April 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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