COMPARISON OF GCS AND FOUR SCORE SCALE TO PREDICT THE NEUROLOGICAL OUTCOME IN PEDIATRICS POPULATION
Keywords:
FOUR Score, Mortality, PICU, GCS.Abstract
Objective: To determine the diagnostic accuracy of FOUR (Full Outline of Unresponsiveness) score for prediction of outcome in pediatric population by taking GCS (Glasgow coma scale) as a gold standard
Study Design: Prospective cohort study
Place and Duration of Study: Pediatric ICU of Combined Military Hospital Lahore from January 2019 to December 2019.
Material and Methods: One hundred and thirty seven patients were included in the study as per the inclusion criteria. Complete neurological exam and initial FOUR score as well as GCS score was recorded for each patient. Diagnostic Accuracy of FOUR score was calculated for prediction of outcome in pediatric population by taking GCS a gold standard.
Results: One hundred and thirty seven patients were included in the study with 81 male and 56 females . The sensitivity of FOUR score was 68.51% while specificity was 81.92%. The agreement between GCS and patients outcome was 56.6% while the agreement between FOUR scale and patients outcome was 72.3%. The Youden index showed that FOUR scales (79.56%) have a better prediction for death than GCS (63.18%).Furthermore, Kappa agreement coefficient (kw) for agreement between FOUR (P=0.00) and GCS (P=0.00) with patient‘s outcome was found statistically significant.
Conclusion: The high yield of FOUR score and inclusion of verbal response makes it superior over GCS as large number of patients in ICU are intubated thus giving us more accurate information about patient‘s neurological status
