• World Neurosurg · Feb 2024

    Development of a Novel Neurological Score Combining GCS and FOUR scales for the Assessment of Neurosurgical Patients with Traumatic Brain Injury; GCS-FOUR Scale.

    • Ali Ansari, Sina Zoghi, Amirabbas Khoshbooei, Mohammad Amin Mosayebi, Maryam Feili, Omid Yousefi, Amin Niakan, Seyed Amin Kouhpayeh, Reza Taheri, and Hosseinali Khalili.
    • Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
    • World Neurosurg. 2024 Feb 1; 182: e866e871e866-e871.

    BackgroundConsciousness assessment is crucial for patients with traumatic brain injury. In this study, we developed a novel scoring system combining the Glasgow coma scale (GCS) and the full outline of unresponsiveness (FOUR) and evaluated its association with the intensive care unit (ICU) length of stay, mortality, and functional outcome.MethodsWe retrospectively analyzed the data from patients with traumatic brain injury admitted to the neurosurgical ICU of our institution during a 2-year period. The eye and motor components of the GCS and the brainstem reflex component of the FOUR were used to compute the GCS-FOUR. We performed statistical analysis to demonstrate the association between the GCS, FOUR, and GCS-FOUR and the ICU length of stay, mortality, the development of a persistent vegetative state, and desirable recovery.ResultsA total of 140 patients were included. The mean age was 30.6 years, and 89.3% were male. All 3 scores were associated with the ICU length of stay, mortality, a persistent vegetative state, and good recovery. In terms of predicting mortality, the GCS score exhibited a slight superiority compared with the other indexes, and the GCS-FOUR score showed a slight superiority over the other indexes in predicting for good recovery.ConclusionsThe GCS-FOUR is a novel scoring system comparable to the GCS and FOUR regarding its association with functional status after injury, ICU length of stay, and mortality. The GCS-FOUR score provides greater neurological detail than the GCS due to the inclusion of brainstem reflexes, in addition to using the experience of healthcare providers with the GCS score compared with the FOUR in most settings.Copyright © 2023 Elsevier Inc. All rights reserved.

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