The Full Outline of UnResponsiveness score is more efficient than the Glasgow Coma Scale in the prognosis of stroke

Year 2019, , 97 - 101, 31.10.2019

Samad Shams Vahdatı Mehdi Farhoudı Mustafa Cıcek Mohsen Salehı Respina Jalılıan Hamed Hojjatpanah

https://doi.org/10.5472/marumj.637561

Abstract

Objectives: After being a solid method of measuring consciousness for decades,the Glasgow Coma Scale (GCS) was offered to be

replaced with a better option: The Full Outline of Unresponsiveness (FOUR) score, which several studies later confirmed to be

superior due to its independence from verbal response and ability to consider brain stem reflexes. In this study, we decided to compare

the two scales in the prognosis of stroke, which has never been conducted before.

Patients and Methods: We conducted both methods on 150 stroke patients during admission to the emergency service and assessed

them during a 3-month follow-up after discharge.

Results: The type of stroke was 80% ischemic and 20% hemorrhagic. 55.3% survived after a 3-month follow-up. The FOUR score had

a significant converse relation with hospitalization, a relation with the GCS lacked. The FOUR score also had a stronger correlation

with the outcome of stroke than the GCS. Additionally, the receiver operating characteristic (ROC) curve showed greater sensitivity

and specificity in the FOUR score in the prognoses of stroke patients.

Conclusion: We recommend using the FOUR score as the first priority.

Keywords

Glasgow Coma Scale, Full Outline of Unresponsiveness score, Stroke, Consciousness, Emergency medicine

References

• 1. Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care 2008;12 Suppl 3:S3. doi: 10.1186/cc6149
• 2. Marino PL. Marino's the ICU Book. Philadelphia: Lippincott Williams and Wilkins, 2013.
• 3. Kocak Y, Ozturk S, Ege F, Ekmekci H. A useful new coma scale in acute stroke patients: FOUR score. Anaesth Intensive Care 2012;40:131-6. doi: 10.1177/0310057X1204000115
• 4. 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 ;155:2133-9. doi: 10.1007/s00701-013-1854-2
• 5. Koennecke HC, Belz W, Berfelde D, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology 2011;77:965-72. doi: 10.1212/WNL.0b013e31822dc795
• 6. Saver JL, Altman H. Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset. Stroke 2012;43:1537-41. doi: 10.1161/STROKEAHA.111.636928
• 7. Fischer M, Ruegg S, Czaplinski A, et al. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care 2010;14:R64. doi: 10.1186/cc8963
• 8. 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 5;77:84-5. doi: 10.1212/WNL.0b013e318220ac06
• 9. Sadaka F, Patel D, Lakshmanan R. The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care 2012;16:95-101. doi: 10.1007/s12028-011-9617-5
• 10. Idrovo L, Fuentes B, Medina J, et al. Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study. Eur Neurol 2010;63:364-9. doi: 10.1159/000292498
• 11. 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. Eur J Emerg Med 2009;16:29-36. doi: 10.1097/MEJ.0b013e32830346ab
• 12. Stead LG, Wijdicks EF, Bhagra A, et al. Validation of a new coma scale, the FOUR score, in the emergency department. Neurocrit Care 2009;10:50-4. doi: 10.1007/s12028-008-9145-0
• 13. Zappa S, Fagoni N, Bertoni M, et al. Determination of imminent brain death using the Full Outline of Unresponsiveness Score and the Glasgow Coma Scale: A prospective, multicenter, pilot feasibility study. J Intensive Care Med 2017 Jan 1:885066617738714. doi: 10.1177/0885066617738714
• 14. 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. 10.1002/ana.20611
• 15. Kornbluth J, Bhardwaj A. Evaluation of coma: a critical appraisal of popular scoring systems. Neurocrit Care 2011;14:134-43. doi: 10.1007/s12028-010-9409-3
• 16. Saika A, Bansal S, Philip M, Devi BI, Shukla DP. Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury. Acta Neurochir (Wien) 2015;157:1323-8. doi: 10.1007/s00701-015-2469-6
• 17. Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EF. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc 2009;84:694-701. doi: 10.1016/S0025-6196(11)60519-3
• 18. 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. Neurocrit Care 2011;15:447-53. doi: 10.1007/s12028-011-9547-2
• 19. McNett M, Amato S, Gianakis A, et al. The FOUR score and GCS as predictors of outcome after traumatic brain injury. Neurocrit Care 2014;21:52-7. doi: 10.1007/s12028-013-9947-6
• 20. Sepahvand E, Jalali R, Mirzaei M, Ebrahimzadeh F, Ahmadi M, Amraii E. Glasgow Coma Scale versus Full Outline of UnResponsiveness Scale for prediction of outcomes in patients with traumatic brain injury in the Intensive Care Unit. Turk Neurosurg 2016;26:720-4. doi: 10.5137/1019-5149.JTN.13536-14.0
• 21. 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;30:211-20. doi: 10.3109/02688697.2016.1161173