Comparison of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in predicting mortality in critically ill patients*.
OBJECTIVE
Impaired consciousness has been incorporated in prediction models that are used in the ICU. The Glasgow Coma Scale has value but is incomplete and cannot be assessed in intubated patients accurately. The Full Outline of UnResponsiveness score may be a better predictor of mortality in critically ill patients.


METHODS
Thirteen ICUs at five U.S. hospitals.


METHODS
One thousand six hundred ninety-five consecutive unselected ICU admissions during a six-month period in 2012.


METHODS
Glasgow Coma Scale and Full Outline of UnResponsiveness score were recorded within 1 hour of admission. Baseline characteristics and physiologic components of the Acute Physiology and Chronic Health Evaluation system, as well as mortality were linked to Glasgow Coma Scale/Full Outline of UnResponsiveness score information.


METHODS
None.


RESULTS
We recruited 1,695 critically ill patients, of which 1,645 with complete data could be linked to data in the Acute Physiology and Chronic Health Evaluation system. The area under the receiver operating characteristic curve of predicting ICU mortality using the Glasgow Coma Scale was 0.715 (95% CI, 0.663-0.768) and using the Full Outline of UnResponsiveness score was 0.742 (95% CI, 0.694-0.790), statistically different (p = 0.001). A similar but nonsignificant difference was found for predicting hospital mortality (p = 0.078). The respiratory and brainstem reflex components of the Full Outline of UnResponsiveness score showed a much wider range of mortality than the verbal component of Glasgow Coma Scale. In multivariable models, the Full Outline of UnResponsiveness score was more useful than the Glasgow Coma Scale for predicting mortality.


CONCLUSIONS
The Full Outline of UnResponsiveness score might be a better prognostic tool of ICU mortality than the Glasgow Coma Scale in critically ill patients, most likely a result of incorporating brainstem reflexes and respiration into the Full Outline of UnResponsiveness score.
1Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN. 2Cerner Corporation, Vienna, VA. 3Department of Trauma and Emergency Surgery, Borgess Medical Center, Kalamazoo, MI. 4Department of Critical Care, Borgess Medical Center, Kalamazoo, MI. 5Department of Critical Care Medicine, Mercy Hospital, St. Louis, MO. 6Project Management/Quality, Spartanburg Regional Medical Center, Spartanburg, SC. 7Performance Improvement Department, St. Mary's Medical Center, Huntington, WV. 8Intensive Care Unit, Shawnee Mission Medical Center, Shawnee Mission, KS.
Eelco F M
EF
Wijdicks
Andrew A
AA
Kramer
Thomas
T
Rohs
Susan
S
Hanna
Farid
F
Sadaka
Jacklyn
J
O'Brien
Shonna
S
Bible
Stacy M
SM
Dickess
Michelle
M
Foss
D018806:APACHE; D001933:Brain Stem / Q000503:physiopathology; D003128:Coma / Q000401:mortality; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015599:Trauma Severity Indices