Comparison of two different tools of consciousness assessment in the intensive care unit

Year 2020, Volume: 10 Issue: 2, 176 - 180, 25.06.2020

Özlem Doğu , Banu Terzi , Özcan Kutlu

https://doi.org/10.16899/jcm.652716

Abstract

Aim: To compare two different consciousness assessment tools used in intensive care units.
Materials and Methods: The prospective observational study was conducted with a total of 29 patients who were followed up in intensive care units. GCS and FOUR scores and modified Rankin Scale (mRS) scores of the patients who were monitored by the same observer for 10 days in the intensive care units were measured and recorded. Mean±standard deviation was used for the values regarding total scale score means. Pearson’s correlation analysis was used for comparing total score means.
Results: GCS and FOUR scores and the mean total mRS scored of the patients on the first day were 6.95±2.25 (range, 3-11), 8.65±2.45 (range, 4-13), and 4.93±0.25 (range, 4-5) respectively. The mean total scale scores on the 10th day were 6.62±3.27 (range, 3-12), 8.13±3.44 (range, 4-13), and 4.89±0.30 (range, 4-5). A statistically significant high-degree relationship was found between the mean total scores of the patients' GCS and FOUR scores (p<0.001).
Conclusion: FOUR can be confidently used instead of GCS for the assessment of consciousness. Comparisons of GCS and FOUR score should be conducted with different patient groups and larger samples. Differences between observers should also be evaluated when comparing the scoring systems.

Keywords

consciousness assessment, Full Outline of UnResponsiveness Score, Glasgow Coma Scale, follow-up, nursing

References

• 1. Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EFM. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clinic Proceedings 2009;84(8):694–701.
• 2. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2(7872):81–84.
• 3. Jennett B. Development of Glasgow Coma and outcome scales. Nepal J Neuroscience 2005;2(1):24-8.
• 4. Sepit D. Level of consciousness: assessment and Glasgow Coma Scale as an assessment tool. HEAD 2005;2(1):12-16.
• 5. Akdemir G. Trauma scoring and Glasgow Coma Scale. Turkiye Klinikleri J Neurosurg-Special Topics 2008;1(1):6-11.
• 6. Middleton PM. Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15(3):170-83.
• 7. Reith FC, Brennan PM, Maas AI, Teasdale GM. Lack of standardization in the use of the Glasgow Coma Scale: results of ınternational surveys. J Neurotrauma 2016;33(1):89-94.
• 8. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR Score. Ann Neurol 2005;58:585-93.
• 9. Wijdicks EF, Rabinstein AA, Bamlet WR, Mandrekar JN. FOUR score and Glasgow Coma Scale in predicting outcome of comatose patients: a pooled analysis. Neurology 2011;77(1):84-5.
• 10. Arlı ŞK. A new scale for evaluating of the consciousness: Four Scor. ACU Sağlık Bilimleri Dergisi 2018;9(3):220-222.
• 11. Bruno MA, Ledoux D, Lambermont B, et al. Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an intensive care unit population. Neurocritical Care 2011;15(3):447-453.
• 12. Eken C, Kartal M, Bacanli A, Eray O. Comparison of the Full Outline of UnResponsiveness Score Coma Scale and the Glasgow Coma Scale in an emergency setting population. Eurasian Journal of Emergency Medicine 2009;16(1):29-36.
• 13. Jalali R, Rezaei M. A comparison of the Glasgow Coma Scale score with full outline of unresponsiveness scale to predict patients’ traumatic brain injury outcomes in intensive care units. Critical Care Research and Practice 2014;2014(Article ID 289803):1-4.
• 14. Koçak Y, Öztürk S, Ege F, Ekmekçi AH. A useful new coma scale in acute stroke patients: FOUR score. Anaesth Intensive Care 2012;40(1):131-136.
• 15. Şahin AS, Şahin M, Öztürk NK, Kızılateş E, Karslı B. Comparision of GCS and FOUR Scores used in the evaluation of neurological status in intensive care units. Journal of Contemporary Medicine 2015;5(3):167-72.
• 16. Örken DN, Sağduyu AK, Şirin H, et al. Yeni Bir Koma Değerlendirme Ölçeği Olan Four Skorun Türkçe Çevirisinin Güvenirlik Çalışması. Reliability of the Turkish Version of a new coma scale: FOUR Score. Trakya Univ Tıp Fak Derg. 2010;27(1):28-31.
• 17. Sacco S, Carolei A. The FOUR Score: A reliable ınstrument to assess the comatose stroke patient. Eur Neurol 2010;63(6):370–371.
• 18. Wolf CA, Wijdicks EFM, Bamlet WR, McClelland RL. Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clin Proc. 2007;82(4):435-438.
• 19. Reith FC, Synnot A, van den Brande R, Gruen RL, Maas AI. Factors influencing the reliability of the Glasgow Coma Scale: A systematic review. Neurosurgery 2017;80(6):829-839.
• 20. Quinn TJ, Dawson J, Walters M. Dr John Rankin; his life, legacy and the 50th anniversary of the Rankin Stroke Scale. Scott Med J 2008;53(1):44–47.
• 21. Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991;54(12):1044–1054.
• 22. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19(5):604–607.
• 23. Aksakallı E, Turan Y, Şendur ÖF. Outcome scales in stroke rehabilitation. Turk J Phys Med Rehab 2009;55(4):168-72.
• 24. Sümer M, Benbir G, Can U, Kutluk K, Uzuner N. Scales: guidelines of Turkish society of cerebrovascular diseases–2015. Turkish Journal of Cerebrovascular Diseases 2015;21(3):185-188.
• 25. Domaç FM, Özden T, Adıgüzel T, Mısırlı H. Nontraumatic hemorrhagic stroke in adults younger than 45 years. Journal of Turkish Cerebrovascular Diseases 2010;16 (2):45-49.
• 26. Büyükcam F, Kaya U, Karakılıç ME, Çavuş UY, Turan F, Odabaş Ö. Predicting the outcome of children with head trauma: Comparison of FOUR score and GCS. Ulus Travma Acil Cerrahi Derg 2012;18(6):469-473.
• 27. Jamal A, Sankhyan N, Jayashree M, Singhi S, Singhi P. Full Outline of Unresponsiveness Score and the Glasgow Coma Scale in prediction of pediatric coma. World J Emerg Med 2017;8(1):55–60.
• 28. 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(5):603-608.
• 29. Hosseini SH, Ayyasi M, Akbari H, Gorji MAH. Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in prediction of mortality rate among patients with traumatic brain injury admitted to intensive care unit. Anesth Pain Med 2017;7(5):e33653.
• 30. Wijdicks EFM. Why you may need a neurologist to see a comatose patient in the ICU. Critical Care 2016:20:193.