Analysis of diagnostic informative value of the Full Outline of UnResponsiveness Scale in patients with spontaneous supratentorial intracerebral hemorrhage

Authors

  • A. A. Kuznietsov Zaporizhzhіa State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.1.155799

Keywords:

hemorrhage, neurological diagnostic technic

Abstract

The main purpose of the study was to verify the diagnostic informative value of the Full Outline of UnResponsiveness Scale in patients with SSICH based on the comparison with neuroimaging criteria of midline shift severity.

Material and methods. Prospective cohort study of 138 patients in acute period of SSICH was conducted, which included clinical assessment (using the Full Outline of UnResponsiveness (FOUR) Scale and the Glasgow Coma Scale (GCS) scores) and neuroimaging estimation of cerebral injury severity. A comparative analysis of Spearman’s rank correlation coefficients (R) and different areas under the receiver operating characteristic curves (derived from the same cases) was conducted with the help of Z statistic.

Results. The Full Outline of UnResponsiveness Scale was verified as a highly informative tool for the presence and severity of midline shift clinical detection (AUC > 0.80, P < 0.0001) in patients with SSICH, whereas the diagnostic informative value of the FOUR scale within the assessment of severe midline shift clinical signs was higher than that for mild midline shift detection (AUC = 0.97 ± 0.02 versus AUC = 0.84 ± 0.05 for septum pellucidum displacement, P = 0.0158; AUC = 0.99 ± 0.01 versus AUC = 0.92 ± 0.03 for pineal gland displacement, P = 0.0269). The Full Outline of UnResponsiveness Scale had a higher diagnostic informative value than the GCS as for the presence of midline shift clinical signs detection (AUC = 0.81 ± 0.03 versus AUC = 0.67 ± 0.04, P = 0.0002; accuracy 77.5 % versus 63.0 %, P = 0.0085), as well as for the clinical assessment of septum pellucidum displacement severity (AUC = 0.80 ± 0.04 versus AUC = 0.73 ± 0.05, P = 0.0286) and pineal gland displacement (AUC = 0.80 ± 0.05 versus AUC = 0.74 ± 0.05, P = 0.0306) in patients with midline shift <4 mm due to SSICH.

Conclusions. The Full Outline of UnResponsiveness Scale is characterized by the higher diagnostic informative value in clinical detecting midline shift severity in patients with SSICH.

References

Baratloo, A., Shokravi, M., Safari, S., & Aziz, A. K. (2016). Predictive Value of Glasgow Coma Score and Full Outline of Unresponsiveness Score on the Outcome of Multiple Trauma Patients. Arch Iran Med, 19(3), 215–220. doi: 0161903/AIM.0011.

Bordini, A. L., Luiz, T. F., Fernandes, M., Arruda, W. O., & Teive, H. A. (2010). Coma scales: a historical review. Arq Neuropsiquiatr, 68(6), 930–937. doi: 10.1590/S0004-282X2010000600019.

Braksick, S. A., Hemphill, J. C., Mandrekar, J., Wijdicks, E. F. M., & Fugate, J. E. (2018). Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis. J Stroke Cerebrovasc Dis, 27(6), 1565–1569. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.008.

Bruno, M. A., Ledoux, D., Lambermont, B., Damas, F., Schnakers, C., Vanhaudenhuyse, A., et al. (2011). Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an intensive care unit population. Neurocrit Care, 15(3), 447–453. doi: 10.1007/s12028-011-9547-2.

Fischer, M., Rüegg, S., Czaplinski, A., Strohmeier, M., Lehmann, A., Tschan, F., et al. (2010). Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care, 14(2), R64. doi: 10.1186/cc8963.

Gorji, M. A., Gorji, A. M., & Hosseini, S. H. (2015). Which score should be used in intubated patients' Glasgow coma scale or full outline of unresponsiveness? Int J Appl Basic Med Res, 5(2), 92–95. doi: 10.4103/2229-516X.157152.

Hu, Y., Wang, C., Yan, X., Fu, H., & Wang, K. (2017). Prediction of conscious awareness recovery after severe acute ischemic stroke. J Neurol Sci, 383, 128–134. doi: 10.1016/j.jns.2017.10.034.

Jalali, R., & Rezaei, M. (2014). A comparison of the glasgow coma scale score with full outline of unresponsiveness scale to predict patients' traumatic brain injury outcomes in intensive care units. Crit Care Res Pract, 2014, 289803. doi: 10.1155/2014/289803.

Kocak, Y., Ozturk, S., Ege, F., & Ekmekci, H. (2012). A useful new coma scale in acute stroke patients: FOUR score. Anaesth Intensive Care, 40(1), 131–136.

Kramer, A. A., Wijdicks, E. F., Snavely, V. L., Dunivan, J. R., Naranjo, L. L., Bible, S., et al. (2012). A multicenter prospective study of interobserver agreement using the Full Outline of Unresponsiveness score coma scale in the intensive care unit. Crit Care Med, 40(9), 2671–2676. doi: 10.1097/CCM.0b013e318258fd88.

Okasha, A. S., Fayed, A. M., & Saleh, A. S. (2014). The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury. Neurocrit Care, 21(3), 496–504. doi: 10.1007/s12028-014-9995-6.

Spina, S., Marzorati, C., Vargiolu, A., Magni, F., Riva, M., Rota, M., et al. (2017). Intracerebral hemorrhage in intensive care unit: early prognostication fallacies. A single center retrospective study. Minerva Anestesiol., 84(5), 572–581. doi: 10.23736/S0375-9393.17.12225-X.

Temiz, N. C., Kose, G., Tehli, O., Acikel, C., & Hatipoglu, S. (2018). A Comparison Between the Effectiveness of Full Outline of Unresponsiveness and Glasgow Coma Score at Neurosurgical Intensive Care Unit Patients. Turk Neurosurg, 28(2), 248–250. doi: 10.5137/1019-5149.JTN.19504-16.0.

Wijdicks, E. F., Kramer, A. A., Rohs, T. Jr., Hanna, S., Sadaka, F., O'Brien, J., et al. (2015). Comparison of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in predicting mortality in critically ill patients. Crit Care Med, 43(2), 439–444. doi: 10.1097/CCM.0000000000000707.

Wijdicks, E. F. (2006). Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score. Rev Neurol Dis., 3(3), 109–117.

Wijdicks, E. F., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L. (2005). Validation of a new coma scale: The FOUR score. Ann Neurol, 58(4), 585–593. doi: 10.1002/ana.20611.

Zweig, M. H., & Campbell, G. (1993). Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem, 39(4), 561–577.

Downloads

How to Cite

1.
Kuznietsov AA. Analysis of diagnostic informative value of the Full Outline of UnResponsiveness Scale in patients with spontaneous supratentorial intracerebral hemorrhage. Zaporozhye Medical Journal [Internet]. 2019Feb.8 [cited 2024Dec.23];(1). Available from: http://zmj.zsmu.edu.ua/article/view/155799

Issue

No. 1 (2019)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)