Schey Jaime E, Schoch Monica, Kerr Debra
School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, Australia.
Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Neurocrit Care. 2024 Nov 5. doi: 10.1007/s12028-024-02150-8.
The Full Outline of UnResponsiveness (FOUR) score was developed to overcome the limitations of the Glasgow Coma Scale (GCS) when assessing individuals with impaired consciousness. We sought to review the evidence regarding the predictive validity of the GCS and FOUR score in intensive care unit (ICU) settings. This review was prospectively registered in PROSPERO (CRD42023420528). Systematic searches of CINAHL, MEDLINE, and Embase were undertaken. Prospective observational studies were included if both GCS and FOUR score were assessed in adults during ICU admission and if mortality and/or validated functional outcome measure scores were collected. Studies were excluded if they exclusively investigated patients with traumatic brain injury. Screening, data extraction, and quality assessment using the Quality in Prognosis Studies tool were conducted by two reviewers. Twenty studies of poor to moderate quality were included. Many studies only included patients with neurological illness and excluded sedated patients, despite high proportions of intubated patients. The FOUR score achieved higher area under the receiver operating characteristic curve values for mortality prediction compared with the GCS, and the FOUR score achieved significantly higher area under the receiver operating characteristic curve values for predictions of ICU mortality. Both coma scales showed similar accuracy in predicting "unfavorable" functional outcome. The FOUR score appeared to be more responsive than the GCS in the ICU, as most patients with a GCS score of 3 obtained FOUR scores between 1 and 8 due to preserved brainstem function. The FOUR score may be superior to the GCS for predicting mortality in ICU settings. Further adequately powered studies with clear, reliable methods for assessment of index and outcome scores are required to clarify the predictive performance of both coma scales in ICUs. Inclusion of sedated patients may improve generalizability of findings in general ICU populations.
无反应性全面评估（FOUR）评分的制定是为了克服格拉斯哥昏迷量表（GCS）在评估意识受损个体时的局限性。我们试图回顾关于GCS和FOUR评分在重症监护病房（ICU）环境中的预测效度的证据。本综述已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023420528）中进行了前瞻性注册。我们对护理学与健康领域数据库（CINAHL）、医学文献数据库（MEDLINE）和荷兰医学文摘数据库（Embase）进行了系统检索。纳入的前瞻性观察性研究需满足在ICU入院期间对成人同时评估GCS和FOUR评分，且收集死亡率和/或经过验证的功能结局测量分数。如果研究仅专门调查创伤性脑损伤患者，则将其排除。由两名 reviewers 使用预后研究质量工具进行筛选、数据提取和质量评估。纳入了20项质量较差至中等的研究。许多研究仅纳入神经系统疾病患者并排除使用镇静剂的患者，尽管插管患者比例很高。与GCS相比，FOUR评分在预测死亡率时的受试者工作特征曲线下面积值更高，并且在预测ICU死亡率时，FOUR评分的受试者工作特征曲线下面积值显著更高。两种昏迷量表在预测“不良”功能结局方面显示出相似的准确性。在ICU中，FOUR评分似乎比GCS更具反应性，因为大多数GCS评分为3的患者由于脑干功能保留，FOUR评分在1至8之间。在ICU环境中，FOUR评分在预测死亡率方面可能优于GCS。需要进一步进行有足够样本量的研究，采用清晰、可靠的方法评估指标和结局分数，以阐明两种昏迷量表在ICU中的预测性能。纳入使用镇静剂的患者可能会提高在一般ICU人群中研究结果的普遍性。
