Predicting the outcome in children with head trauma: Comparison of FOUR score and Glasgow Coma Scale

Abstract

Background Because of the limitations of the Glasgow Coma Scale (GCS), many scoring systems have emerged and been compared with GCS. Herein, we investigated whether the Full Outline of Unresponsiveness (FOUR) score is better than GCS in predicting morbidity and mortality in children with head trauma. Methods Patients 2-17 years of age who admitted to the emergency department with head trauma and presented with altered level of consciousness were included in this study. Inhospital mortality, hospitalization of more than three days, and Glasgow Outcome Score (GOS) at discharge and after three months were used as the primary outcome measures. Results A total of 100 children were included in the study. The median age was 6 years, and 69% were male. The in-hospital mortality rate was 10%. The cut-off values for predicting in-hospital mortality were 9 for FOUR score and 7 for GCS. Area under the curve (AUC) values in predicting inhospital mortality, poor GOS (score of 1-3) at discharge, and poor GOS after three months were similar for GCS and FOUR score. Conclusion FOUR score provides no significant advantage over GCS in predicting morbidity and mortality in children with head trauma.