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VOLUME 28 , ISSUE 3 ( March, 2024 ) > List of Articles

Original Article

Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury

Abraham L Chawnchhim, Charu Mahajan, Indu Kapoor, Tej P Sinha, Hemanshu Prabhakar, Arvind Chaturvedi

Keywords : Extended Glasgow outcome score, Full outline of UnResponsiveness score, Glasgow coma scale – Pupils score, Glasgow coma score, Traumatic brain injury

Citation Information : Chawnchhim AL, Mahajan C, Kapoor I, Sinha TP, Prabhakar H, Chaturvedi A. Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury. Indian J Crit Care Med 2024; 28 (3):256-264.

DOI: 10.5005/jp-journals-10071-24651

License: CC BY-NC 4.0

Published Online: 29-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI). Materials and methods: The study was carried out between October 2020 and March 2022. Patients who presented to the hospital with TBI were assessed for inclusion. Initial coma scores were assessed in the emergency department and again after 48 hours of admission. Outcome was assessed using the extended Glasgow outcome score (GOSE) at 3 months after injury. The receiver operating curve (ROC) was plotted to correlate coma scores with the outcome, and the area under the curve (AUC) was compared. Results: A total of 355 patients with TBI were assessed for eligibility, of which 204 patients were included in the study. The AUC values to predict poor outcomes for initial GCS, FOUR, and GCS-P scores were 0.75 each. The AUC values for 48-hour coma scores were 0.88, 0.87, and 0.88, respectively. Conclusion: The GCS, FOUR, and GCS-P scores were found to be comparable in predicting the functional outcome at 3 months as assessed by GOSE. However, coma scores assessed at 48 hours were better predictors of poor outcomes at 3 months than coma scores recorded initially at the time of hospital admission.


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  1. Teasdale G, Maas AI, Lecky F, Manley G, Stocchetti N, Murray G, et al. The Glasgow coma scale at 40 years: Standing the test of time. Lancet Neurol 2014;13(8):844–854. DOI: 10.1016/S1474-4422(14)70120-6.
  2. Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol 2005;58(4):585–593. DOI: 10.1002/ana.20611.
  3. Brennan PM, Murray GD, Teasdale G. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS – Pupils score: An extended index of clinical severity. J Neurosurg 2018;128(6): 1612–1620. DOI: 10.3171/2017.12.JNS172780.
  4. Murray GD, Brennan PM, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. Part 2: Graphical presentation of probabilities. J Neurosurg 2018;128(6):1621–1634. DOI: 10.3171/2017.12.JNS172782.
  5. McNett M, Amato S, Gianakis A, Grimm D, Philippbar SA, Belle J, et al. The FOUR score and GCS as predictors of outcome after traumatic brain injury. Neurocritical care 2014;21(1):52–57. DOI: 10.1007/s12028-013-9947-6.
  6. McNett M, Amato S, Philippbar SA. A comparative study of Glasgow coma scale and full outline of unResponsiveness scores for iredicting long-term outcome after brain injury. J Neurosci Nurs 2017;48(4): 207–214. DOI: 10.1097/JNN.0000000000000225.
  7. 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 units. Indian J Crit Care Med 2016;20:473–476. DOI: 10.4103/0972-5229.188199.
  8. Jalali R, Rezaei M. A comparison of the Glasgow coma scale score with full outline of unResponsiveness score to predict patients’ traumatic brain injury outcomes in intensive care units. Crit Care Res Pract 2014;2014:289803. DOI: 10.1155/2014/289803.
  9. Wijdicks EFM, Kramer AA, Rohs T Jr, Hanna S, Sadaka F, O'Brien J, et al. Comparison of the full outline of unResponsiveness score and Glasgow coma scale in predicting mortality in critically ill patients. Crit Care Med 2015;43:439–444. DOI: 10.1097/CCM.0000000000000707.
  10. Javvaji PK, Nagatham P, Venkata RR, Puttam H, John SK, Karavalla H, et al. A comparison of full outline of unResponsiveness score with Glasgow coma scale score in predicting outcomes among patients with altered mental status admitted to the critical care unit. Indian J Crit Care Med 2022;26(2):210–215. DOI: 10.5005/jp-journals-10071-23921.
  11. Ghelichkhani P, Esmaeili M, Hosseini M, Seylani K. Glasgow coma scale and FOUR score in predicting the mortality of trauma patients: A diagnostic accuracy study. Emerg (Tehran) 2018;6(1):e42. PMCID: PMC6289152.
  12. Mahajan C, Sengupta D, Kapoor I, Prabhakar H, Kumar V, Purohit S, et al. Evaluation of the GCS – pupils score for PrOgnosis in trauMatic brAin injury: The COMA study. Brain Inj 2023;37(9):1041–1047. DOI: 10.1080/02699052.2023.2227943.
  13. Ahmadi S, Sarveazad A, Babahajian A, Ahmadzadeh K, Yousefifard M. Comparison of Glasgow coma scale and full outline of unResponsiveness score for prediction of in-hospital mortality in traumatic brain injury patients: A systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023;49(4):1693–1706. DOI: 10.1007/s00068-022-02111-w.
  14. Akavipat P, Sookplung P, Kaewsingha P, Maunsaiyat P. Prediction of discharge outcome with the full outline of unResponsiveness (FOUR) score in neurological patients. Acta Med Okayama 2011;65(3): 205–210. DOI: 10.18926/AMO/46633.
  15. Lin Y, Zhang S, Zhang W, Wang X, Huang L, Luo H. The prediction value of Glasgow coma scale – pupils score in neurocritical patients: A retrospective study. Brain Injury 2021;35(5)547–553. DOI: 10.1080/02699052.2021.1890821.
  16. Balakrishnan B, VanDongen–Trimmer H, Kim I, Hanson SJ, Zhang L, Simpson PM, et al. GCS – pupil score has a stronger association with mortality and poor functional outcome than GCS alone in pediatric severe traumatic brain injury. Pediatr Neurosurg 2021;56(5):432–439. DOI: 10.1159/000517330.
  17. Kasprowic K, Burzynska M, Melcer T, Kübler A. A comparison of the full outline of unResponsiveness (FOUR) score and Glasgow coma score in predictive modelling in traumatic brain injury. Br J Neurosurg 2016;30(2):211–220. DOI: 10.3109/02688697.2016.1161173.
  18. Agrawal N, Iyer SS, Patil V, Kulkarni S, Shah JN, Jedge P. Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India. Acute Crit Care 2023;38(2):226–233. DOI: 10.4266/acc.2023.00570.
  19. Babu BVM, Bhashyam S, Lakshmi BS. Comparison of predictive value of Glasgow coma scale versus full outline of unResponsiveness (FOUR) score on the outcome of head injury patients admitted to intensive care unit. J Evolution Med Dent Sci 2017;6(28):2300–2304. DOI: 10.14260/Jemds/2017/495.
  20. Okasha AS, Fayed AM, Saleh AS. The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury. Neurocrit Care 2014;21(3):496–504. DOI: 10.1007/s12028-014-9995-6.
  21. Kim YJ. The impact of time from ED arrival to surgery on mortality and hospital length of stay in patients with traumatic brain injury. J Emerg Nurs 2011;37(4):328–333. DOI: 10.1016/j.jen.2010. 04.017.
  22. Mkubwa JJ, Bedada AG, Esterhuizen TM. Traumatic brain injury: Association between the Glasgow coma scale score and intensive care unit mortality. South Afr J Crit Care 2022;38(2):10.7196/SAJCC.2022.v38i2.525. DOI: 10.7196/SAJCC.2022.v38i2.525.
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