title: The FOUR score and GCS as predictors of outcome after traumatic brain injury.
abstract: BACKGROUND
  The Glasgow Coma Scale (GCS) is a routine component of a neurological exam for critically ill traumatic brain injury (TBI) patients, yet has been criticized for not accurately depicting verbal status among intubated patients or including 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. The aims of this study were to: (1) examine correlations between 24 and 72 h FOUR and GCS scores and functional/cognitive outcomes; (2) determine relationship between 24 and 72 h 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 h. Functional outcome measured by functional independence measure scores at rehabilitation discharge; cognitive status measured by Weschler Memory Scale scores 3 months post-injury.
  
  
  RESULTS
  n = 136. Mean age 53.1. 72 h FOUR and GCS scores correlated with functional outcome (r s = 0.34, p = 0.05; r s = 0.39, p = 0.02), but not cognitive status. Receiver operating characteristic curves were comparable for FOUR and GCS at 24 and 72 h for functional status (24 h FOUR, GCS = 0.625, 0.602, respectively; 72 h FOUR, GCS = 0.640, 0.688), cognitive status (24 h FOUR, GCS = 0.703, 0.731; 72 h FOUR, GCS = 0.837, 0.674), and mortality (24 h FOUR, GCS = 0.913, 0.935; 72 h FOUR, GCS = 0.837, 0.884).
  
  
  CONCLUSIONS
  FOUR is comparable to GCS in terms of predictive ability for functional status, cognitive outcome 3 months post-injury, and in-hospital mortality.
authors.affiliation: Department of Nursing Research, The MetroHealth System, Cleveland, OH, USA, mmcnett@metrohealth.org.
authors.forename: Molly
authors.initials: M
authors.lastname: McNett
authors.forename: Shelly
authors.initials: S
authors.lastname: Amato
authors.forename: Anastasia
authors.initials: A
authors.lastname: Gianakis
authors.forename: Dawn
authors.initials: D
authors.lastname: Grimm
authors.forename: Sue Ann
authors.initials: SA
authors.lastname: Philippbar
authors.forename: Josie
authors.initials: J
authors.lastname: Belle
authors.forename: Cristina
authors.initials: C
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult