Full outline of unresponsiveness versus Glasgow coma scale in predicting mortality in paediatric trauma patients
DOI:
https://doi.org/10.18203/2349-2902.isj20192947Keywords:
Glasgow coma scale, Wounds and injuries, Trauma severity indices, Outcome assessment (health care)Abstract
Background: Many scoring models have been proposed for evaluating level of consciousness in trauma patients. The aim of this study is to compare Glasgow coma scale (GCS) and full outline of unresponsiveness (FOUR) score in predicting the morbidity and mortality of trauma paediatric patients.
Methods: In this diagnostic accuracy study trauma paediatric patients hospitalized in emergency room (ER) of Menoufia University hospital were evaluated. GCS and FOUR score of each patient were simultaneously calculated on admission as well as 6, 12 and 24 hours after that. The predictive values of the two scores and their area under the receiver operating characteristics (ROC) curve were compared.
Results: 100 patients were included in the present study (mean age 7.6±5.1; 77% male). Comparing the area under the ROC curve of GCS and FOUR score showed that these values were not different at any of the evaluated times: on admission (p=0.68), and 6 hours (p=0.13), 12 hours (p=0.18). However, The values of FOUR score was high accuracy than GCS score in predicting mortality in paediatric patients with ROC; 0.97, 0.89 respectively.
Conclusions: The results of our study showed that, GCS and FOUR score have the same value in predicting the mortality of trauma patients in first 24 hours. However, FOUR score has high accuracy than GCS score after 24 hours. Both tools had high predictive power in predicting the outcome at the time of discharge.
References
Gururaj G, Kolluri SVR, Chandramouli BA, Subbakrishna DK, Kraus JF. Traumatic Brain Injury. National Institute Mental Health Neuro Sciences. 2005;61.
Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24:24-8.
Ommaya AK. Trauma to the nervous system. Ann R Coll Surg Engl. 1966;39:317-47.
Jouvet M. Coma and other disorders of consciousness. In: Vinken PJ, Bruyn GW. Handbook of Clinical Neurology. Amsterdam: North-Holland Publishing Company; 1969.
Shakhnovich AR, Mamadaliev AM, Abakumova Lla. The prognosis of the outcomes of comatose states in the first 24 hours following craniocerebral trauma. Zh Vopr Neirokhir Im N N Burdenko. 1991;6:11-2.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81-4.
Posner JB. Clinical evaluation of the unconscious patient. Clin Neurosurg. 1975;22:281-301.
Sternbach GL. The Glasgow Coma Scale. J Emerg Med. 2000;19:67-71.
Marrubini M. Classifications of coma. Intensive Care Med. 1984;10:217-26.
Sugiura K, Muraoka K, Chishiki T, Baba M. The Edinburgh-2 coma scale: a new scale for assessing impaired consciousness. Neurosurgery. 1983;12(4):411-5.
Born JD. The glasgow-liege scale. prognostic value and evolution of motor response and brain stem reflexes after severe head injury. Acta Neurochir. 1988;91:1-11.
Brain resuscitation clinical trial II study group. A randomized clinical study of a calcium entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med. 1991;324:1225-31.
Stanczak DE, White JG, Gouview WD. Assessment of level of consciousness following severe neurological insult a comparison of the psychometric qualities of the glasgow coma scale and the comprehensive level of consciousness scale. J Neurosurg. 1984;60:955-60.
Starmark JE, Stalhammar D, Holmgren E. The reaction level scale (RLS85). Manual and guidelines. Acta Neurochir. 1988;91(1-2):12-20.
Benzer A, Mitterschiffthaler G, Marosi M. Prediction of non-survival after trauma. Innsbruck Coma Scale. Lancet. 1991;338:977-8.
Wijdicks EFM, Kokmen E, O’brien PC. Measurement of impaired consciousness in the neurological intensive care unit: a new test. J Neurol Neurosurg Psychiatry. 1998;64:117-9.
Born JD, Albert A, Hans P, Bonnal J. Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury. Neurosurgery. 1985;16(5):595-601.
Sahin AS, Sahin M, Ozturk NK, Kizilates E, KarslÄs´ B. Comparision of GCS And FOUR scores used in the evaluation of neurological status in intensive care units. J Contemp Med. 2015;5(3):167-72.
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.
Gujjar AR, Jacob PC, Nandhagopal R, Ganguly SS, Obaidy A, Al-Asmi AR. Full outline of un responsiveness score and glasgow coma scale in medical patients with altered sensorium: inter rater reliability and relation to outcome. J Crit Care. 2013;28(3):316.e1-8.
Temiz NC, Kose G, Tehli O, Acikel C, Hatipoglu S. A comparison between the effectiveness of full outline of unresponsiveness and Glasgow coma score at neurosurgical intensive care unit patients. Turk Neurosurg. 2016.
Nair SS, Surendran A, Prabhakar RB, Chisthi MM. Comparison between FOUR score and GCS in assessing patients with traumatic head injury: a tertiary centre study. Int Surg J. 2017;4(2):656.
Wolf CA, Wijdicks EF, Bamlet WR, McClelland RL (eds). Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clinic Proceedings: Elsevier; 2007.
Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout SS. The conundrum of the glasgow coma scale in intubated patients: a linear regression prediction of the glasgow verbal score from the Glasgow eye and motor scores. J Trauma. 1998;44(5):839-45.
Jagger J, Jane JA, Rimel R. The glasgow coma scale: to sum or not to sum? Lancet. 1983;2(8341):97.
Rowley G, Fielding K. Reliability and accuracy of the glasgow coma scale with experienced and inexperienced users. Lancet. 1991;337:535-8.
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. Crit Care Res Pract. 2014;289:803-4.
