The FOUR Score Predicts Outcome in Patients After Traumatic Brain Injury

Abstract

The FOUR score is an accurate predictor of outcome in TBI patients. It has some advantages over GCS, such as all components of FOUR score but not GCS can be rated in intubated patients.

Glasgow coma scale versus full outline of unresponsiveness scale for prediction of outcomes in patients with traumatic brain injury in intensive care unit

“…Neurological impairments are a major challenge for ICU patients and those with neurological damage. In line with other studies, the present study results indicate that FOUR is a correct predictor of mortality in ICU patients with traumatic brain injuries (1,14,19). FOUR is easy to use, and provides better information, particularly in intubated patients, and shows depth of coma in greater details compared to GCS, since it assesses brain stem reflexes and respiratory pattern (18).…”

“…Following correct assessment, the nurse is enabled to identify neurological changes in patients, and contact medical team to begin emergency actions to improve survival outcomes (4). To provide quality patient care, nurses should be able to correctly assess the patient (19). Assessment of coma and damage to consciousness level is essential in monitoring neurology patients in the special care unit (12).…”

“…Thus, a precise assessment of patient's consciousness in brain accident cannot be performed) (3), Revised Trauma Scale (RTS), motor, verbal, abdominal, respiratory, circulation scale (CRAMS), Trauma Grading System (TRISS), APACHE II, Ranko scale, Rador scale, and GCS (Glasgow Coma Scale) (11,20). Among these trauma severity grading systems, GCS that combines above systems has become a gold standard (19). Assessment of severity of injury is essential in clinical management of patients following brain trauma, and design of clinical trials aims to determine new treatments (7).…”

“…GCS is a practical tool for classification of intensity of coma in patients with traumatic brain injuries, even though reliability of GCS in predicting patients' outcome is unsatisfactory (19). Incomplete assessment of verbal response in intubated patients and inability to test brain stem reflexes are among failures of GCS (18).…”

Looking for an ideal coma scale: It is time to replace GCS

“…As a result probability of in hospital mortality is higher for the lowest total FOUR score when compared with that of GCS. FOUR score has been subjected to validation studies [11][12][13][14][15][16] in different scenarios like neuro ICU, emergency departments, medical ICU, comatose stroke patients in acute stroke unit , traumatic brain injuries etc. It has been compared with GCS in these validation studies and excellent inter rater agreements have been observed.…”