A Comparison of the Glasgow Coma Scale With Full Outline of Unresponsiveness Scale in Prediction of Patient Outcomes in the Critical Care Unit at Kenyatta National Hospital

Abstract

Background: Neurological assessment is essential in determining the condition, prognosis, and management of critically ill patients. An appropriate scale is essential in the early stage of patient assessment for proper decision making and prediction of patient outcomes. The Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness scale (FOUR) are some of the scoring tools used for assessment of critically ill patients. Broad objective: The main goal of the study was to compare the performance of the GCS with FOUR scales in the prediction of patient outcomes in ICU, Kenyatta National Hospital (KNH). Methodology: This was an analytical prospective study carried out at the critical care units at KNH. Census method was used to select 55 ICU clients who met the study criteria. Data was analyzed using SPSS version 24. Categorical data was analyzed using percentages while continuous data was analyzed using standard deviation and mean. The performance of the GCS and FOUR scores in predicting survival was analyzed using binary logistic regression. Survival analysis was performed by the use of Kaplan Meier method. A Spearman rank correlation analysis was performed to determine the strength of the relationship between GCS prediction, FOUR scale prediction in relation to the actual outcome. Sensitivity analysis was used to determine the reliability of GCS and FOUR scale in predicting actual outcome. ROC curves were computed to assess the accuracy of GCS and FOUR scale based on Area Under the Curve analysis. Calculation of cut-off points was calculated and determination of overall accuracy of prediction of results, sensitivity, and specificity was identified. Results: Of the 55 patients assessed, 67% of the patients were male; the mean age was 41 years, the average length of stay was ten days. Most patients were referrals from other facilities. Patients with a low level of GCS below 6, at admission, were 40%, at 48 hours they were 39% and for low scores of FOUR(less than 9) at admission were 47%, at 48 hours were 39% while those with high scores(above 14) were 40%. The survival rate for both scales at 48 hours was 100%, which continued to decrease as the days went by. On the 14th day, the predicted survival was 50% while the actual survival for the patients was 65%. The sensitivity of GCS at admission was 47.4% and 98% on the day of evaluation while FOUR score at admission was 68.4% and on day 14 was 100%. At 48 hours and 14 days of admission to the ICU, FOUR score was able to accurately predict the survival rate of patient outcomes. Dissemination: Findings were delivered to the School of Nursing for thesis defense, Ethics, and review committee, published in one of the international journals and will be presented during the annual general scientific conference. Recommendations: The researcher recommends a larger study to be done to confirm that FOUR score is a more reliable tool for assessment of ICU patients.