title: FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury.
abstract: The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients.
  
  
  
  From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled. Three advanced practice nurses administered the FOUR score, GCS, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Therapeutic Intervention Scoring System (TISS) concurrently from ICU admissions. The endpoint of observation was mortality when the patients left the ICU. Data are presented as frequency with percentages, mean with standard deviation, or median with interquartile range. Each measurement tool used area under the receiver operating characteristic curve to compare the predictive power between these four tools. In addition, the difference between survival and death was estimated using the Wilcoxon rank sum test.
  
  
  
  From 55 TBI patients, males (72.73 %) were represented more than females, the mean age was 63.1 ± 17.9, and 19 of 55 observations (35 %) had a maximum FOUR score of 16. The overall mortality rate was 14.6 %. The area under the receiver operating characteristic curve was 74.47 % for the FOUR score, 74.73 % for the GCS, 81.78 % for the APACHE II, and 53.32 % for the TISS. The FOUR score has similar predictive power of mortality compared to the GCS and APACHE II. Each of the parameters-E, M, B, and R-of the FOUR score showed a significant difference between mortality and survival group, while the verbal and eye-opening components of the GCS did not.
  
  
  
  Having similar predictive power of mortality compared to the GCS and APACHE II, the FOUR score can be used as an alternative in the prediction of early mortality in TBI patients in the ICU.
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.
authors.forename: Tee-Tau Eric
authors.initials: TE
authors.lastname: Nyam
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.
authors.forename: Kam-Hou
authors.initials: KH
authors.lastname: Ao
authors.affiliation: Department of Nursing, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Department of Nursing, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Mei-Li
authors.initials: ML
authors.lastname: Shen
authors.affiliation: Department of Nursing, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan. kuojinnrung@gmail.com.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. kuojinnrung@gmail.com.
authors.forename: Jinn-Rung
authors.initials: JR
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012720:Severity of Illness Index
keywords: APACHE II; FOUR score; Glasgow Coma Scale; ROC curve; Therapeutic Interventions Scoring System; Traumatic brain injury