Daily FOUR score assessment provides accurate prognosis of long-term outcome in out-of-hospital cardiac arrest.
BACKGROUND
The accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response.


OBJECTIVE
To evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA.


METHODS
We prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC).


RESULTS
Eighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC 3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76) sensitivity, 0.94 (0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00) PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome.


CONCLUSIONS
The absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA.
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: nicolas.weiss@egp.aphp.fr.
N
N
Weiss
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
M
M
Venot
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
F
F
Verdonk
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
A
A
Chardon
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
L
L
Le Guennec
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
M C
MC
Llerena
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Q
Q
Raimbourg
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
G
G
Taldir
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Y
Y
Luque
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
J-Y
JY
Fagon
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
E
E
Guerot
Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
J-L
JL
Diehl
D016887:Cardiopulmonary Resuscitation; D003422:Critical Care / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D016896:Treatment Outcome
Arrêt cardiaque; Cardiac arrest; Coma; FOUR score; Glasgow Coma Scale; Prognostication; Pronostic; Score de Glasgow