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

BACKGROUND: Consciousness assessment is crucial in patients with traumatic brain injury (TBI). 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 Intensive Care Unit (ICU) length of stay, mortality, and functional outcome.

METHODS: We retrospectively analyzed the data of patients with TBI admitted to the neurosurgical ICU of our institution in a period of 2 years. The eye and motor component of GCS and the brainstem reflex component of FOUR were utilized to compute GCS-FOUR. We performed statistical analysis to demonstrate the association between GCS, FOUR, and GCS-FOUR and ICU length of stay, mortality, development of persistent vegetative states, and desirable recovery.

RESULTS: A total of 140 patients were included. The mean age was 30.6 years and 89.3% were male. All three scores were associated with ICU length of stay, mortality, persistent vegetative states, and good recovery. In terms of predicting mortality, the GCS score exhibited a slight superiority over the other indices, while the GCS-FOUR score showed a slight superiority over the other indices in predicting good recovery.

CONCLUSION: GCS-FOUR is a novel scoring system comparable to GCS and FOUR regarding its association with functional status post-injury, ICU length of stay, and mortality. GCS-FOUR score provides greater neurological detail than the GCS due to inclusion of brainstem reflexes on top of utilizing the experience of healthcare providers with GCS score as opposed to FOUR in a majority of settings.