Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study.
OBJECTIVE
To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS).


METHODS
All intubated critically ill patients with a disturbed level of consciousness were assessed using both the FOUR score and the GCS. The FOUR score and the GCS were compared regarding their predictive value for successful extubation at 14 days after intubation as a primary outcome measure. The 28-day mortality and the neurological outcome at 3 months were used as secondary outcome measures.


RESULTS
Eighty-six patients were included in the study. Median age was 63 (50-77) years. Sex-ratio (M/F) was 1.46. On admission, median GCS was 7 (3-10) while median FOUR score was 8.5 (2.3-11). A GCS ≤ 7 predicted the extubation failure at 14 days after intubation with a sensitivity of 88.5% and specificity of 68.3%, whereas a FOUR score <10 predicted the same outcome with a sensitivity of 80.8% and a specificity of 81.7%. The areas under the curves was significantly higher with the FOUR score than with GCS (respectively 0.867 confidence interval [CI]: 95% [0790-0.944] and 0.832 CI: 95% [0.741-0.923];P= 0.014). When calculated before extubation, FOUR score <12 predicted extubation failure with a sensitivity of 92.3% and a specificity of 85%, whereas a GCS <12 predicted the same outcome with a sensitivity of 73% and a specificity of 61.7%. Both scores had similar accuracy for predicting 28-day mortality and neurological outcome at 3 months.


CONCLUSIONS
The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients.
Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.
Tarek
T
Said
Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.
Anis
A
Chaari
Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.
Karim Abdel
KA
Hakim
Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.
Dalia
D
Hamama
Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.
William Francis
WF
Casey
Extubation; full outline of unresponsiveness score; glasgow coma scale