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

Abstract

Background: This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods: We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson’s correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. Results: In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. Conclusions: The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

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

“… 5 , 6 , 17 On comparison of GCS and GCS-P, the latter is considered a better predictor of outcome than GCS alone. 15 , 16 Our study found all three coma scores to be comparable for prediction of mortality and 3 months poor outcome, which is in agreement with another recent study by Agrawal et al 18 This can be largely due to differences in study design, severity of TBI in sampled patients and sample size in the earlier studies.…”

Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit

“…The GCS is a widely used scale for assessing the level of consciousness, with scores ranging from 3 to 15. Previous studies have consistently demonstrated the importance of the GCS score in evaluating the severity of neurological disorders 21 , 25 , 26 . The SOFA score serves as a valuable tool for quantifying the extent of organ dysfunction or failure at the point of ICU admission and has found widespread application in predicting in-hospital mortality in this setting 27 – 29 .…”