• Rev Neurol France · May 2015

    Daily FOUR score assessment provides accurate prognosis of long-term outcome in out-of-hospital cardiac arrest.

    • N Weiss, M Venot, F Verdonk, A Chardon, L Le Guennec, M C Llerena, Q Raimbourg, G Taldir, Y Luque, J-Y Fagon, E Guerot, and J-L Diehl.
    • Medical Critical Care Department, Georges-Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: nicolas.weiss@egp.aphp.fr.
    • Rev Neurol France. 2015 May 1; 171 (5): 437-44.

    BackgroundThe accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response.ObjectiveTo evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA.MethodsWe prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC).ResultsEighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC 3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76) sensitivity, 0.94 (0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00) PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome.ConclusionThe absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA.Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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