Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis

Sherri A. Braksick, J. Claude Hemphill, Jayawant Mandrekar, Eelco F.M. Wijdicks, Jennifer E. Fugate

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The Full Outline of Unresponsiveness (FOUR) Score is a validated scale describing the essentials of a coma examination, including motor response, eye opening and eye movements, brainstem reflexes, and respiratory pattern. We incorporated the FOUR Score into the existing ICH Score and evaluated its accuracy of risk assessment in spontaneous intracerebral hemorrhage (ICH). Materials and Methods: Consecutive patients admitted to our institution from 2009 to 2012 with spontaneous ICH were reviewed. The ICH Score was calculated using patient age, hemorrhage location, hemorrhage volume, evidence of intraventricular extension, and Glasgow Coma Scale (GCS). The FOUR Score was then incorporated into the ICH Score as a substitute for the GCS (ICH ScoreFS). The ability of the 2 scores to predict mortality at 1 month was then compared. Results: In total, 274 patients met the inclusion criteria. The median age was 73 years (interquartile range 60-82) and 138 (50.4%) were male. Overall mortality at 1 month was 28.8% (n = 79). The area under the receiver operating characteristic curve was.91 for the ICH Score and.89 for the ICH ScoreFS. For ICH Scores of 1, 2, 3, 4, and 5, 1-month mortality was 4.2%, 29.9%, 62.5%, 95.0%, and 100%. In the ICH ScoreFS model, mortality was 10.7%, 26.5%, 64.5%, 88.9%, and 100% for scores of 1, 2, 3, 4, and 5, respectively. Conclusions: The ICH Score and the ICH ScoreFS predict 1-month mortality with comparable accuracy. As the FOUR Score provides additional clinical information regarding patient status, it may be a reasonable substitute for the GCS into the ICH Score.

Original languageEnglish (US)
Pages (from-to)1565-1569
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume27
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Cerebral Hemorrhage
Glasgow Coma Scale
Mortality
Hemorrhage
Aptitude
Coma
Eye Movements
ROC Curve
Brain Stem
Reflex

Keywords

  • FOUR Score
  • Glasgow Coma Scale
  • ICH Score
  • Intracerebral hemorrhage
  • prognosis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis. / Braksick, Sherri A.; Hemphill, J. Claude; Mandrekar, Jayawant; Wijdicks, Eelco F.M.; Fugate, Jennifer E.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 27, No. 6, 01.06.2018, p. 1565-1569.

Research output: Contribution to journalArticle

Braksick, Sherri A. ; Hemphill, J. Claude ; Mandrekar, Jayawant ; Wijdicks, Eelco F.M. ; Fugate, Jennifer E. / Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis. In: Journal of Stroke and Cerebrovascular Diseases. 2018 ; Vol. 27, No. 6. pp. 1565-1569.
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abstract = "Background: The Full Outline of Unresponsiveness (FOUR) Score is a validated scale describing the essentials of a coma examination, including motor response, eye opening and eye movements, brainstem reflexes, and respiratory pattern. We incorporated the FOUR Score into the existing ICH Score and evaluated its accuracy of risk assessment in spontaneous intracerebral hemorrhage (ICH). Materials and Methods: Consecutive patients admitted to our institution from 2009 to 2012 with spontaneous ICH were reviewed. The ICH Score was calculated using patient age, hemorrhage location, hemorrhage volume, evidence of intraventricular extension, and Glasgow Coma Scale (GCS). The FOUR Score was then incorporated into the ICH Score as a substitute for the GCS (ICH ScoreFS). The ability of the 2 scores to predict mortality at 1 month was then compared. Results: In total, 274 patients met the inclusion criteria. The median age was 73 years (interquartile range 60-82) and 138 (50.4{\%}) were male. Overall mortality at 1 month was 28.8{\%} (n = 79). The area under the receiver operating characteristic curve was.91 for the ICH Score and.89 for the ICH ScoreFS. For ICH Scores of 1, 2, 3, 4, and 5, 1-month mortality was 4.2{\%}, 29.9{\%}, 62.5{\%}, 95.0{\%}, and 100{\%}. In the ICH ScoreFS model, mortality was 10.7{\%}, 26.5{\%}, 64.5{\%}, 88.9{\%}, and 100{\%} for scores of 1, 2, 3, 4, and 5, respectively. Conclusions: The ICH Score and the ICH ScoreFS predict 1-month mortality with comparable accuracy. As the FOUR Score provides additional clinical information regarding patient status, it may be a reasonable substitute for the GCS into the ICH Score.",
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T1 - Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis

AU - Braksick, Sherri A.

AU - Hemphill, J. Claude

AU - Mandrekar, Jayawant

AU - Wijdicks, Eelco F.M.

AU - Fugate, Jennifer E.

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AB - Background: The Full Outline of Unresponsiveness (FOUR) Score is a validated scale describing the essentials of a coma examination, including motor response, eye opening and eye movements, brainstem reflexes, and respiratory pattern. We incorporated the FOUR Score into the existing ICH Score and evaluated its accuracy of risk assessment in spontaneous intracerebral hemorrhage (ICH). Materials and Methods: Consecutive patients admitted to our institution from 2009 to 2012 with spontaneous ICH were reviewed. The ICH Score was calculated using patient age, hemorrhage location, hemorrhage volume, evidence of intraventricular extension, and Glasgow Coma Scale (GCS). The FOUR Score was then incorporated into the ICH Score as a substitute for the GCS (ICH ScoreFS). The ability of the 2 scores to predict mortality at 1 month was then compared. Results: In total, 274 patients met the inclusion criteria. The median age was 73 years (interquartile range 60-82) and 138 (50.4%) were male. Overall mortality at 1 month was 28.8% (n = 79). The area under the receiver operating characteristic curve was.91 for the ICH Score and.89 for the ICH ScoreFS. For ICH Scores of 1, 2, 3, 4, and 5, 1-month mortality was 4.2%, 29.9%, 62.5%, 95.0%, and 100%. In the ICH ScoreFS model, mortality was 10.7%, 26.5%, 64.5%, 88.9%, and 100% for scores of 1, 2, 3, 4, and 5, respectively. Conclusions: The ICH Score and the ICH ScoreFS predict 1-month mortality with comparable accuracy. As the FOUR Score provides additional clinical information regarding patient status, it may be a reasonable substitute for the GCS into the ICH Score.

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