The FOUR score and GCS as Predictors of Outcome After Traumatic Brain Injury

2.50
Hdl Handle:
http://hdl.handle.net/10755/300691
Category:
Abstract
Type:
Research Study
Level of Evidence:
Cohort Study
Research Approach:
Quantitative Research
Title:
The FOUR score and GCS as Predictors of Outcome After Traumatic Brain Injury
Author(s):
McNett, Molly
Lead Author STTI Affiliation:
Delta Xi
Author Details:
Molly McNett, PhD, RN, CNRN
Abstract:

Introduction:Seventy-one percent (71%) of traumatic brain injury (TBI) hospitalizations necessitate critical care monitoring.  The Glasgow Coma Scale (GCS) is a routine component of a neurological exam, yet does not accurately depict verbal status among intubated patients or include brain stem reflexes.  Preliminary research on the Full Outline of UnResponsiveness (FOUR) scale suggests it overcomes these limitations.  Research is needed to determine correlations with patient outcomes.  Study aims were to: (1) Examine correlations between 24 and 72 hour FOUR and GCS scores and functional/cognitive outcomes; (2) Determine relationship between 24 and 72 hour FOUR scores and mortality.

Methods: Prospective cohort study.  Data gathered on adult TBI patients at a Level I trauma center. FOUR scores assigned at 24, 72 hours. Functional outcome measured by discharge functional independence measure (FIM); cognitive status measured by Weschler Memory Scale Scores (WMS-III) 3 months post injury.

Results:n=138. Mean age 53.1. 72 hr FOUR and GCS scores correlated with functional outcome (rs=0.3432 p=0.05; rs=0.3931, p=0.03), but not cognitive status. Odds ratios (OR) for  24 hour FOUR and GCS were comparable in predicting mortality [0.76 (0.66-0.87); 0.71 (0.59-0.85)], and higher with 72 hour scores [72 hr FOUR 0.76 (0.66-.087); 72 hr GCS 0.71 (0.59-0.85)]. When controlling for age/gender, greater decreases were seen in OR for GCS over FOUR scores.

Conclusions: FOUR is comparable to GCS and predictive of mortality and functional outcome. The scale eliminates the verbal component of the neurological exam, providing a more accurate clinical picture when assessing the critically ill adult.

Keywords:
brain injury; coma scale
MeSH:
Coma--diagnosis; Brain Injuries--diagnosis
Repository Posting Date:
3-Sep-2013
Date of Publication:
3-Sep-2013
Sponsors:
Sigma Theta Tau International
Note:
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.; This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.evidence.levelCohort Studyen
dc.research.approachQuantitative Researchen
dc.titleThe FOUR score and GCS as Predictors of Outcome After Traumatic Brain Injuryen_US
dc.contributor.authorMcNett, Molly-
dc.contributor.departmentDelta Xien
dc.author.detailsMolly McNett, PhD, RN, CNRNen
dc.identifier.urihttp://hdl.handle.net/10755/300691-
dc.description.abstract<p class="MsoNormal" style="margin: 0in 0in 0pt; line-height: 200%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">Introduction</span></strong><span style="text-decoration: underline;">:</span>Seventy-one percent (71%) of traumatic brain injury (TBI) hospitalizations necessitate critical care monitoring.<span style="mso-spacerun: yes;">  </span>The Glasgow Coma Scale (GCS) is a routine component of a neurological exam, yet does not accurately depict verbal status among intubated patients or include brain stem reflexes.<span style="mso-spacerun: yes;">  </span>Preliminary research on the Full Outline of UnResponsiveness (FOUR) scale suggests it overcomes these limitations.<span style="mso-spacerun: yes;">  </span>Research is needed to determine correlations with patient outcomes.<span style="mso-spacerun: yes;">  </span>Study aims were to:<strong style="mso-bidi-font-weight: normal;"> </strong>(1)<strong style="mso-bidi-font-weight: normal;"> </strong><span class="printanswer"><span style="mso-bidi-font-weight: bold;">Examine correlations between 24 and 72 hour FOUR and GCS scores and functional/cognitive outcomes;</span><strong style="mso-bidi-font-weight: normal;"> </strong>(2)<strong style="mso-bidi-font-weight: normal;"> </strong><span style="mso-bidi-font-weight: bold;">Determine relationship between 24 and 72 hour FOUR scores and mortality.</span></span></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; line-height: 200%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">Methods</span></strong><span style="text-decoration: underline;">:</span><span class="printanswer"> Prospective cohort study.<span style="mso-spacerun: yes;">  </span>Data gathered on adult TBI patients at a Level I trauma center. FOUR scores assigned at 24, 72 hours. Functional outcome measured by discharge functional independence measure (FIM); cognitive status measured by Weschler Memory Scale Scores (WMS-III) 3 months post injury. </span></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; line-height: 200%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">Results:</span></strong><em style="mso-bidi-font-style: normal;">n</em>=138. Mean age 53.1. 72 hr FOUR and GCS scores correlated with functional outcome (r<sub>s</sub>=0.3432 <em style="mso-bidi-font-style: normal;">p</em>=0.05; r<sub>s</sub>=0.3931, <em style="mso-bidi-font-style: normal;">p</em>=0.03), but not cognitive status. Odds ratios (OR) for <span style="mso-spacerun: yes;"> </span>24 hour FOUR and GCS were comparable in predicting mortality [0.76 (0.66-0.87); 0.71 (0.59-0.85)], and higher with 72 hour scores [72 hr FOUR 0.76 (0.66-.087); 72 hr GCS 0.71 (0.59-0.85)]. When controlling for age/gender, greater decreases were seen in OR for GCS over FOUR scores.</span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; line-height: 200%; mso-layout-grid-align: none;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">Conclusions</span></strong>: FOUR is comparable to GCS and predictive of mortality and functional outcome. The scale eliminates the verbal component of the neurological exam, providing a more accurate clinical picture when assessing the critically ill adult.</span></span></p>en_GB
dc.subjectbrain injuryen_GB
dc.subjectcoma scaleen_GB
dc.subject.meshComa--diagnosisen_US
dc.subject.meshBrain Injuries--diagnosisen_US
dc.date.available2013-09-03T18:00:17Z-
dc.date.issued2013-09-03-
dc.date.accessioned2013-09-03T18:00:17Z-
dc.description.sponsorshipSigma Theta Tau Internationalen
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.-
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