title: The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury.
abstract: BACKGROUND
  The Glasgow Coma Scale (GCS) is the most widely accepted scale for assessing levels of consciousness, clinical status, as well as prognosis of traumatic brain injury (TBI) patients. The Full Outline of UnResponsiveness (FOUR) score is a new coma scale developed addressing the limitations of the GCS. The aim of this prospective cohort study was to compare the performance of the FOUR score vs. the GCS in predicting TBI outcomes.
  
  
  METHODS
  From April to July 2011, 60 consecutive adult patients with TBI admitted to the Alexandria Main University Hospital intensive care units (ICU) were enrolled in the study. GCS and FOUR score were documented on arrival to emergency room. Outcomes were in-hospital mortality, unfavorable outcome [Glasgow outcome scale extended (GOSE) 1-4], endotracheal intubation, and ICU length of stay (LOS).
  
  
  RESULTS
  Fifteen (25 %) patients died and 35 (58 %) had unfavorable outcome. When predicting mortality, the FOUR score showed significantly higher area under receiver operating characteristic curve (AUC) than the GCS score (0.850 vs. 0.796, p = 0.025). The FOUR score and the GCS score were not different in predicting unfavorable outcome (AUC 0.813 vs. 0.779, p = 0.136) and endotracheal intubation (AUC 0.961 vs. 0.982, p = 0.06). Both scores were good predictors of ICU LOS (r (2) = 0.40 [FOUR score] vs. 0.41 [GCS score]).
  
  
  CONCLUSIONS
  The FOUR score was superior to the GCS in predicting in-hospital mortality in TBI patients. There was no difference between both scores in predicting unfavorable outcome, endotracheal intubation, and ICU LOS.
authors.affiliation: Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Ahmed Said
authors.initials: AS
authors.lastname: Okasha
authors.forename: Akram Muhammad
authors.initials: AM
authors.lastname: Fayed
authors.forename: Ahmad Sabry
authors.initials: AS
authors.lastname: Saleh
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015599:Trauma Severity Indices