Predicting Outcome in Subarachnoid Hemorrhage (SAH) Utilizing the Full Outline of UnResponsiveness (FOUR) Score

• Published in: Neurocritical care Vol. 27; no. 3; pp. 381 - 391
• Main Authors: Zeiler, F. A., Lo, B. W. Y., Akoth, E., Silvaggio, J., Kaufmann, A. M., Teitelbaum, J., West, M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2017; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Cornea; Critical Care Medicine; Edema; Female; Glasgow Coma Scale; Glasgow Outcome Scale; Hemorrhage; Humans; Hydrocephalus; Intensive; Internal Medicine; Intracranial Aneurysm - complications; Ischemia; Length of stay; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Neurosurgery; Original Article; Ostomy; Outcome Assessment (Health Care) - methods; Pain; Patients; Physician assistants; Respiration; Severity of Illness Index; Statistical analysis; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - etiology; Tracheotomy; Traumatic brain injury; Ventilators; Full Outline of UnResponsiveness; SAH; Outcome prediction; Subarachnoid hemorrhage; Aneurysm
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-017-0396-5

Background
Existing scoring systems for aneurysmal subarachnoid hemorrhage (SAH) patients fail to accurately predict patient outcome. Our goal was to prospectively study the Full Outline of UnResponsiveness (FOUR) score as applied to newly admitted aneurysmal SAH patients.
Methods
All adult patients presenting to Health Sciences Center in Winnipeg from January 2013 to July 2015 (2.5 year period) with aneurysmal SAH were prospectively enrolled in this study. All patients were followed up to 6 months. FOUR score was calculated upon admission, with repeat calculation at 7 and 14 days. The primary outcomes were: mortality, as well as dichotomized 1- and 6-month Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) values.
Results
Sixty-four patients were included, with a mean age of 54.2 years (range 26–85 years). The mean FOUR score upon admission pre- and post-external ventricular drain (EVD) was 10.3 (range 0–16) and 11.1 (range 3–16), respectively. There was a statistically significant association between pre-EVD FOUR score (total, eye, respiratory and motor sub-scores) with mortality, 1-month GOS, and 6-month GOS/mRS (
p
 < 0.05 in all). The day 7 total, eye, respiratory, and motor FOUR scores were associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS (
p
 < 0.05 in all). The day 14 total, eye, respiratory, and motor FOUR scores were associated with 6-month GOS (
p
 < 0.05 in all). The day 7 cumulative FOUR score was associated with the development of clinical vasospasm (
p
 < 0.05).
Conclusions
The FOUR score at admission and day 7 post-SAH is associated with mortality, 1-month GOS/mRS, and 6-month GOS/mRS. The FOUR score at day 14 post-SAH is associated with 6-month GOS. The brainstem sub-score was not associated with 1- or 6-month primary outcomes.