FOUR has the Best Predictive Validity for Patients with Severe Consciousness Disorders or Mechanical Ventilation

Abstract Background: To investigate the predictive validity of GCS, GCS-Pupils and FOUR for patients admitted to the Neuro-Surgical ICU. Methods: In this retrospective study, all the adult patients admitted to Neuro-Surgical ICU from January 2017 to January 2020 were recruited. The GCS, GCS-pupils and FOUR scores were obtained at their ICU admission. Correlation analyses were conducted between the scores and the outcomes. Results: 181 patients were included in the outcomes analysis. The average scores of GCS was 5 (3-9), GCS-Pupils was 5 (1-10) and FOUR was 7 (0-16).The scores of all the three scales were correlated with the primary outcome (6-month GOSE), FOUR had the best predictive value(OR=0.5, 95%CI: 0.4~0.5) and the most refined cut-off value.The scores of the FOUR and GCS-Pupils were correlated with all the secondary outcomes(p0.05). In the subgroup analysis of more severe patients, the scores of FOUR were correlated with all the outcomes(p0.05), the scores of the GCS-Pupils were not correlated with the outcomes(p>0.05). Conclusions: FOUR has the best predictive validity for patients admitted to NSICU, especially for those with severe consciousness disorders or mechanical ventilation.