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Original Article
- Trauma
- 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
- Nishant Agrawal, Shivakumar S Iyer, Vishwanath Patil, Sampada Kulkarni, Jignesh N Shah, Prashant Jedge
- Acute Crit Care. 2023;38(2):226-233. Published online May 25, 2023
- DOI: https://doi.org/10.4266/acc.2023.00570
- 15,396 View
- 334 Download
- 8 Web of Science
- 11 Crossref
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Abstract
PDF - 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. -
Citations
Citations to this article as recorded by
- Glasgow coma scale (GCS), GCS-pupil score (GCS-P), and full outline of unresponsiveness (FOUR) score in traumatic brain injury patients: A comparative study of inter-observer variability and prognostic ability
Manisha Patlan, Navneh Samagh, Ankita Dey, Shashank Paliwal, Jyoti Sharma, Varun Aggarwal
Journal of Anaesthesiology Clinical Pharmacology.2026;[Epub] CrossRef - Association Between Glasgow Coma Scale Trajectory and In‐Hospital Mortality in Traumatic Brain Injury in the ICU: A Retrospective Cohort Study
Yangchun Zhang, Feng Chen, Na Ma, Cairong Liu, Xufeng Chen, Xueli Ji
Nursing in Critical Care.2025;[Epub] CrossRef - Epidemiology and Outcome of Traumatic Brain Injuries: A Retrospective Study in a Tertiary Care Center
Rudra N Shah, Yam B Roka, Ashish J Thapa, Alok Jha, Chandan N Sah
Cureus.2025;[Epub] CrossRef - Comparison of the Accuracy of the GCS and FOUR Scores in Predicting Mortality of Patients with Traumatic Brain Injury (TBI) Admitted to the Emergency Department: A Prospective Study in Khorramabad, Iran
Amirhossein Pashaei, Soodabeh Zare, Peiman Bakhshi, Sara Fakhri
Shiraz E-Medical Journal.2025;[Epub] CrossRef - Dynamic assessment of the prognostic value of scoring systems FOUR, GCS and CRS-R in patients with chronic critical illness after acute brain injury
L. B. Berikashvili, M. Ya. Yadgarov, D. V. Zhidilyaev, K. K. Kadantseva, E. M. Korolenok, A. A. Yakovlev, A. N. Kuzovlev, V. V. Likhvantsev
Messenger of ANESTHESIOLOGY AND RESUSCITATION.2025; 22(6): 39. CrossRef - ASSOCIATION OF AGE AND FOUR SCORE WITH ICU LENGTH OF STAY IN POST-CRANIOTOMY PATIENTS AT SAKINAH HOSPITAL MOJOKERTO
Rudi Hariyono, Ika Ainur Rofi’ah
International Journal of Nursing and Midwifery Science (IJNMS).2025; 9(3): 506. CrossRef - Development of a Novel Neurological Score Combining GCS and FOUR Scales for Assessment of Neurosurgical Patients with Traumatic Brain Injury: GCS-FOUR Scale
Ali Ansari, Sina Zoghi, Amirabbas Khoshbooei, Mohammad Amin Mosayebi, Maryam Feili, Omid Yousefi, Amin Niakan, Seyed Amin Kouhpayeh, Reza Taheri, Hosseinali Khalili
World Neurosurgery.2024; 182: e866. CrossRef - Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury
Indu Kapoor, Hemanshu Prabhakar, Arvind Chaturvedi, Charu Mahajan, Abraham L Chawnchhim, Tej P Sinha
Indian Journal of Critical Care Medicine.2024; 28(3): 256. CrossRef - Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit
Baojie Mao, Lichao Ling, Yuhang Pan, Rui Zhang, Wanning Zheng, Yanfei Shen, Wei Lu, Yuning Lu, Shanhu Xu, Jiong Wu, Ming Wang, Shu Wan
Scientific Reports.2024;[Epub] CrossRef - The assessment of consciousness status in primary brainstem hemorrhage (PBH) patients can be achieved by monitoring changes in basic vital signs
Shiyi Zuo, Yuting Feng, Juan Sun, Guofang Liu, Hanxu Cai, Xiaolong Zhang, Zhian Hu, Yong Liu, Zhongxiang Yao
Geriatric Nursing.2024; 59: 498. CrossRef - Traumatic brain injury in companion animals: Pathophysiology and treatment
Molly Wart, Thomas H. Edwards, Julie A. Rizzo, Geoffrey W. Peitz, Armi Pigott, Jonathan M. Levine, Nicholas D. Jeffery
Topics in Companion Animal Medicine.2024; 63: 100927. CrossRef
- Glasgow coma scale (GCS), GCS-pupil score (GCS-P), and full outline of unresponsiveness (FOUR) score in traumatic brain injury patients: A comparative study of inter-observer variability and prognostic ability
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