title: Predicting Outcome in Subarachnoid Hemorrhage (SAH) Utilizing the Full Outline of UnResponsiveness (FOUR) Score.
abstract: BACKGROUND
  Existing scoring systems for aneurysmal subarachnoid hemorrhage (SAH) patients fail to accurately predict patient outcome. Our goal was to prospectively study the Full Outline of UnResponsiveness (FOUR) score as applied to newly admitted aneurysmal SAH patients.
  
  
  METHODS
  All adult patients presenting to Health Sciences Center in Winnipeg from January 2013 to July 2015 (2.5 year period) with aneurysmal SAH were prospectively enrolled in this study. All patients were followed up to 6 months. FOUR score was calculated upon admission, with repeat calculation at 7 and 14 days. The primary outcomes were: mortality, as well as dichotomized 1- and 6-month Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) values.
  
  
  RESULTS
  Sixty-four patients were included, with a mean age of 54.2 years (range 26-85 years). The mean FOUR score upon admission pre- and post-external ventricular drain (EVD) was 10.3 (range 0-16) and 11.1 (range 3-16), respectively. There was a statistically significant association between pre-EVD FOUR score (total, eye, respiratory and motor sub-scores) with mortality, 1-month GOS, and 6-month GOS/mRS (p < 0.05 in all). The day 7 total, eye, respiratory, and motor FOUR scores were associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS (p < 0.05 in all). The day 14 total, eye, respiratory, and motor FOUR scores were associated with 6-month GOS (p < 0.05 in all). The day 7 cumulative FOUR score was associated with the development of clinical vasospasm (p < 0.05).
  
  
  CONCLUSIONS
  The FOUR score at admission and day 7 post-SAH is associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS. The FOUR score at day 14 post-SAH is associated with 6-month GOS. The brainstem sub-score was not associated with 1- or 6-month primary outcomes.
authors.affiliation: Section of Neurosurgery, Department of Surgery, Health Sciences Center, University of Manitoba, GB-1 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada. umzeiler@myumanitoba.ca.|Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada. umzeiler@myumanitoba.ca.|Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. umzeiler@myumanitoba.ca.
authors.forename: F A
authors.initials: FA
authors.lastname: Zeiler
authors.affiliation: Section of Neurosurgery and Neurocritical Care, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.|Section of Neurocritical Care, Montreal Neurological Institute, Montreal, QC, Canada.
authors.forename: B W Y
authors.initials: BWY
authors.lastname: Lo
authors.affiliation: Section of Neurosurgery, Department of Surgery, Health Sciences Center, University of Manitoba, GB-1 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Akoth
authors.affiliation: Section of Neurosurgery, Department of Surgery, Health Sciences Center, University of Manitoba, GB-1 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Silvaggio
authors.affiliation: Section of Neurosurgery, Department of Surgery, Health Sciences Center, University of Manitoba, GB-1 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Kaufmann
authors.affiliation: Section of Neurocritical Care, Montreal Neurological Institute, Montreal, QC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Teitelbaum
authors.affiliation: Section of Neurosurgery, Department of Surgery, Health Sciences Center, University of Manitoba, GB-1 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
authors.forename: M
authors.initials: M
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000209:etiology
keywords: Aneurysm; Full Outline of UnResponsiveness; Outcome prediction; SAH; Subarachnoid hemorrhage