Correlation Between Full Outline Unresponsiveness Score and Glasgow Coma Scale for Severe Head Injury Patients at Prof. dr. R. D. Kandou General Hospital, Manado-Indonesia

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W Jusuf
E Prasetyo
M Oley


GCS, FOUR score, level of consciousness, severe head injury


Objective: Glasgow Coma Scale (GCS) has been widely used to assess level of consciousness related
to trauma, however, its use have a limitation especially in intubated patients. Full Outline
Unresponsiveness Score (FOUR) consists of four components (eye, motor, brainstem, and respiration)
and each component has a maximal score of 4 and total score 17. This study aims to evaluate
correlation between FOUR score and GCS to evaluate level of consciousness in severe head injury
Methods: This is a prospective study with correlation approach. We prospectively studied all
severe head injury patients at surgical emergency department Kandou Hospital, Manado from March
to May 2010. Level of consciousness was assessed using GCS and FOUR score. Data were analysed
with Pearson correlation coefficient.
Results: From March to May 2010 at surgical emergency
department there were 27 severe head injury patients (24 males and 3 females) with average range of
age 10-20 years old (29,6%). The highest distribution of GCS in severe head injury patients were
GCS 8 (33.3%) and GCS 3 (22.2%) while in FOUR score were 8 (33.3%) and 7 (14.8%).
Conclusions: we concluded that FOUR score can be used as important tools to assess level of
consciousness of severe head injury patents. FOUR score provides greater neurological detail than
GCS which can assess brainstem reflexes, breathing pattern, and herniation.

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