The four score compared glasgow coma scale to evaluate the patients with intubation at emergency room

Abstract

Background: The level of consciousness of patient is important at emergency room for a treatment plan quickly and efficiently. Many tools have been developed to evaluate various ways to help in assessing the limit of GCS score. One of them is the FOUR (Full Outline of UnResponsiveness) score, new coma scale, evaluates 4 components: eye and motor responses, brainstem reflexes and respiration pattern. Therefore this study was to compare FOUR score and GCS for use in patients with intubation in the emergency room. Method: 80 patients with intubation at ER have evaluate by random pair of rater ( ED Residents, ED Nurses, Extern on duty at ER) both FOUR and GCS score in each patient and tracking information until the patients are discharged from the hospital. The statistical of study used Willcoxon’ s sign rank test to determine differences between group, Spearman’s and Kendall’s correlation to determine correlation between FOUR and GCS , weighted kappa and ICC to determine the degree of agreement and the logistic regression for in-hospital death. Results: Inter-rater agreement were good to excellent for FOUR score ( Kw =0.80, ICC= 0.96, 95%CI 0.93-0.97) and GCS score (Kw=0.83, ICC= 0.92, 95%CI 0.96-0.98) and there were no statistical significant differences between rater types. The score’s correlation was good ( r=0.82, T=0.74, p< 0.01). Every 1-point increase in total scores, there were reduction in odds of in-hospital mortality (FOUR: OR= 0.87, 95% CI 0.67- 1.10 ; GCS: OR= 0.91, 95% CI 0.57- 1.45). Conclusion: The FOUR score is reliable for evaluate the patient with intubation at ER. The FOUR score can be used to predict in-hospital mortality.