Nunes Dos Santos Mariana Sofia, Stayt Louise Caroline
Neuro ICU, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, United Kingdom.
Oxford Brookes University, OX3 0BP, United Kingdom.
Intensive Crit Care Nurs. 2025 Aug;89:104048. doi: 10.1016/j.iccn.2025.104048. Epub 2025 May 7.
Traumatic brain-injury (TBI) is one of the leading causes of death and disability worldwide. In intensive care, the Glasgow coma scale (GCS) is widely used to assess severity of brain injury. An alternative tool is the Full Outline of UnResponsiveness (FOUR) score which assesses stages of locked-in syndrome and brain herniation. The purpose of this study is to evaluate the effectiveness of both assessment tools in predicting mortality and morbidity in critically ill patients with TBI.
Systematic review guided by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis (2021). A comprehensive database search was conducted for the period January 2005-September 2023. Searches repeated in February 2025. Primary research comparing FOUR with GCS, published in English, including adults aged 16 and over and patients with TBIs in intensive care were included. Studies were appraised using JBI critical appraisal tools. Data was narratively synthesised.
Eleven studies were included. No study reported significant statistical differences between GCS and FOUR score in predicting mortality. Area under the curve and receiving operating characteristic curve values for both tools were rated good to excellent (Range 0.80-0.96) in predicting mortality. Morbidity was only reported in 6/11 studies. Neither tool appeared to effectively predict morbidity however, there was great variability in which and how morbidity outcomes were assessed.
Both assessment tools perform similarly in predicting mortality and morbidity in TBI in intensive care.
Further research to determine the additional clinical benefits of FOUR assessment in this population is recommended. The development of core morbidity outcome measures in patients with TBI is required to evaluate if these tools effectively predict morbidity. Effective prognostication may assist healthcare providers in managing resources as well as providing patients and families with realistic expectations of long-term recovery.
创伤性脑损伤（TBI）是全球范围内死亡和残疾的主要原因之一。在重症监护中，格拉斯哥昏迷量表（GCS）被广泛用于评估脑损伤的严重程度。另一种工具是无反应性全面概述（FOUR）评分，它用于评估闭锁综合征和脑疝的阶段。本研究的目的是评估这两种评估工具在预测重症TBI患者死亡率和发病率方面的有效性。
由乔安娜·布里格斯研究所（JBI）证据综合手册（2021年）指导进行系统评价。对2005年1月至2023年9月期间进行了全面的数据库搜索。2025年2月重复搜索。纳入以英文发表的、比较FOUR与GCS的原发性研究，包括16岁及以上的成年人以及重症监护中的TBI患者。使用JBI批判性评估工具对研究进行评估。对数据进行叙述性综合。
纳入了11项研究。没有研究报告GCS和FOUR评分在预测死亡率方面有显著统计学差异。两种工具在预测死亡率方面的曲线下面积和接受操作特征曲线值被评为良好至优秀（范围0.80 - 0.96）。发病率仅在11项研究中的6项中有所报告。然而，两种工具似乎都不能有效预测发病率，而且在评估发病率结果的内容和方式上存在很大差异。
在预测重症监护中TBI患者的死亡率和发病率方面，这两种评估工具表现相似。
建议进行进一步研究以确定FOUR评估在该人群中的额外临床益处。需要制定TBI患者的核心发病率结局指标，以评估这些工具是否能有效预测发病率。有效的预后评估可能有助于医疗保健提供者管理资源，并为患者及其家属提供对长期康复的现实期望。
