Advantages of using the FOUR scale in intensive care unit in patients with severe traumatic brain injury

INTRODUCTION: Severe traumatic brain injuries (STBI) are one of the leading causes of death and disability among the world’s population. One of the reasons for poor patient outcomes is underestimating the severity of the brain injury. The Glasgow Coma Scale (GCS) is used to assess the degree of consciousness depression in conditions of the neurosurgical intensive care unit (NICU). The current FOUR (Full Outline of UnResponsiveness) scale is better suited for assessing and monitoring patients in the ICU.

OBJECTIVES: The primary goal of our study is the assessment of the effectiveness and benefits of the FOUR scales in comparison with the GCS scale in NICU patients with STBI.

METHODS: Monitoring and assessment of patients were carried out at two clinical hospitals in NICU for three months by using both FOUR and GCS scales. Patients that were in deep medical sedation or had the lesion of the spinal cord were excluded from observation. The results obtained were summarized and analyzed.

Results: 21 patients were included in the study during the observation period. The obtained results were summarised and analyzed. The structure of diagnoses includes intracranial hemorrhage/cerebral contusion (n=11), subarachnoid hemorrhage (n=11), subdural hematomas (n=9), epidural hematomas (n=2), dislocation of the median structures more than 5 mm relative to the median line (n=4).

CONCLUSION: The use of the FOUR scales has several key advantages, such as higher predictive ability, linear relationship between assessment and outcome, assessment of brain stem structures.

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