Comparison between FOUR score and GCS in assessing patients with traumatic brain injury

Abstract

Background: Head injuries are a major cause of morbidity and mortality across the world. To ensure the maximum favourable outcome, effective initial assessment and early intervention is of importance in patients with traumatic brain injury. Distinctive approaches to determining severity early after injury include neuroimaging, assessing the presence of an altered consciousness or loss of consciousness, assessing the presence of posttraumatic amnesia, and applying the various traumatic severity assessing scores like Glasgow Coma Scale score. The Glasgow Coma Scale is a clinical tool designed to assess coma and impaired consciousness and is one of the most commonly used TBI severity scoring systems. The “Full Outline of Unresponsiveness (FOUR) score,” a novel scale created to provide a more thorough assessment. The FOUR score offers extra details that the GCS cannot estimate, such as brainstem reflexes, visual tracking, breathing patterns, and respiratory drive.

Aim: To evaluate the efficacy of FOUR score in comparison with GCS score on the day of arrival, Day 1 and Day 2 of traumatic head injury patients.

Materials & Methods: This is a prospective observational study conducted in the Emergency medicine department of Kauvery speciality hospital, Trichy. Patients primarily presenting to ER with head injury are included in the study. Glasgow Coma scale and FOUR score are recorded for all the head injury patients on the day of admission, on Day 1 and Day 2with their demographic details. Data will be noted in proforma and calculated using SPSS.

Results: In our study population majority belonged to above 40 years of age and majority were male patients. The correlation between FOUR score for all 3 days were strong with GCS for all 3 days.

Conclusion: Our results shows that FOUR score have better ways to predict the neurological implications for brain stem reflexes at a early period than GCS.