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Eelco F. M. Wijdicks - One of the best experts on this subject based on the ideXlab platform.

  • comparison of the full outline of unresponsiveness score and the glasgow Coma Scale in predicting mortality in critically ill patients
    Critical Care Medicine, 2015
    Co-Authors: Eelco F. M. Wijdicks, Andrew A Kramer, Thomas Rohs, Susan Hanna, Farid Sadaka, Jacklyn Obrien, Shonna Bible, Stacy M Dickess, Michelle Foss
    Abstract:

    Objective Impaired consciousness has been incorporated in prediction models that are used in the ICU. The Glasgow Coma Scale has value but is incomplete and cannot be assessed in intubated patients accurately. The Full Outline of UnResponsiveness score may be a better predictor of mortality in critically ill patients. Setting Thirteen ICUs at five U.S. hospitals. Subjects One thousand six hundred ninety-five consecutive unselected ICU admissions during a six-month period in 2012. Design Glasgow Coma Scale and Full Outline of UnResponsiveness score were recorded within 1 hour of admission. Baseline characteristics and physiologic components of the Acute Physiology and Chronic Health Evaluation system, as well as mortality were linked to Glasgow Coma Scale/Full Outline of UnResponsiveness score information. Interventions None. Measurements and results We recruited 1,695 critically ill patients, of which 1,645 with complete data could be linked to data in the Acute Physiology and Chronic Health Evaluation system. The area under the receiver operating characteristic curve of predicting ICU mortality using the Glasgow Coma Scale was 0.715 (95% CI, 0.663-0.768) and using the Full Outline of UnResponsiveness score was 0.742 (95% CI, 0.694-0.790), statistically different (p = 0.001). A similar but nonsignificant difference was found for predicting hospital mortality (p = 0.078). The respiratory and brainstem reflex components of the Full Outline of UnResponsiveness score showed a much wider range of mortality than the verbal component of Glasgow Coma Scale. In multivariable models, the Full Outline of UnResponsiveness score was more useful than the Glasgow Coma Scale for predicting mortality. Conclusions The Full Outline of UnResponsiveness score might be a better prognostic tool of ICU mortality than the Glasgow Coma Scale in critically ill patients, most likely a result of incorporating brainstem reflexes and respiration into the Full Outline of UnResponsiveness score.

  • four score and glasgow Coma Scale in predicting outcome of Comatose patients a pooled analysis
    Neurology, 2011
    Co-Authors: Eelco F. M. Wijdicks, William R Bamlet, Alejandro A Rabinstein, Jay Mandrekar
    Abstract:

    The Glasgow Coma Scale (GCS) has positioned itself as a major prognostic marker for outcome in Comatose patients. The recent introduction of a more detailed Scale—the Full Outline of Unresponsiveness (FOUR) score—has provided the opportunity to analyze its predictive value and compare it to GCS as the current standard. Several prospective studies have validated the FOUR score as a reliable tool in assessing stuporous and Comatose patients (figure e-1 on the Neurology ® Web site at www.neurology.org). In this pooled analysis, we compare the value of low sumscores to predict outcome in the GCS and FOUR score. ### Methods. In this study, we analyzed the data of all previously performed prospective studies and used a summary receiver operating characteristic curve to predict outcome after presentation with an acute neurologic condition. Prior tabulated data from 4 prospective studies1,–,4 were reanalyzed. Poor outcome …

  • validity of the four score Coma Scale in the medical intensive care unit
    Mayo Clinic proceedings, 2009
    Co-Authors: Vivek N Iyer, Jayawant N Mandrekar, Richard D Danielson, Alexander Y Zubkov, Jennifer Elmer, Eelco F. M. Wijdicks
    Abstract:

    OBJECTIVE To evaluate the validity of the FOUR (Full Outline of UnResponsiveness) score (ranging from 0 to 16), a new Coma Scale consisting of 4 components (eye response, motor response, brainstem reflexes, and respiration pattern), when used by the staff members of a medical intensive care unit (ICU). PATIENTS AND METHODS This interobserver agreement study prospectively evaluated the use of the FOUR score to describe the condition of 100 critically ill patients from May 1, 2007, to April 30, 2008. We compared the FOUR score to the Glasgow Coma Scale (GCS) score. For each patient, the FOUR score and the GCS score were determined by a randomly selected staff pair (nurse/fellow, nurse/consultant, fellow/fellow, or fellow/consultant). Pair wise weighted κ values were calculated for both scores for each observer pair. RESULTS The interrater agreement with the FOUR score was excellent (weighted κ: eye response, 0.96; motor response, 0.97; brainstem reflex, 0.98; respiration pattern, 1.00) and similar to that obtained with the GCS (weighted κ: eye response, 0.96; motor response, 0.97; verbal response, 0.98). In terms of the predictive power for poor neurologic outcome (Modified Rankin Scale score, 3-6), the area under the receiver operating characteristic curve was 0.75 for the FOUR score and 0.76 for the GCS score. The mortality rate for patients with the lowest FOUR score of 0 (89%) was higher than that for patients with the lowest GCS score of 3 (71%). CONCLUSION The interrater agreement of FOUR score results was excellent among medical intensivists. In contrast to the GCS, all components of the FOUR score can be rated even when patients have undergone intubation. The FOUR score is a good predictor of the prognosis of critically ill patients and has important advantages over the GCS in the ICU setting.

  • validation of a new Coma Scale the four score in the emergency department
    Neurocritical Care, 2009
    Co-Authors: L G Stead, Eelco F. M. Wijdicks, Anjali Bhagra, Rahul Kashyap, Fernanda M Bellolio, David L Nash, S Enduri, Raquel M Schears, Bamlet William
    Abstract:

    Objective Full Outline of Unresponsiveness (FOUR) score has previously been validated Scale in the Neurosciences Intensive Care Unit. In this study, we sought to validate the use of FOUR score in the emergency department (ED) using non-neurology staff. We also compared its performance to the Glasgow Coma Scale (GCS) and correlated it to functional outcome at hospital discharge and overall survival.

  • further validation of the four score Coma Scale by intensive care nurses
    Mayo Clinic proceedings, 2007
    Co-Authors: Chris A Wolf, Eelco F. M. Wijdicks, William R Bamlet, Robyn L Mcclelland
    Abstract:

    OBJECTIVE The FOUR (Full Outline of UnResponsiveness) score is a new Coma Scale that consists of 4 components (eye, motor, brainstem, and respiration). The Scale was recently validated, but variability among nursing staff has been documented. PATIENTS AND METHODS We prospectively studied the FOUR score in 80 patients with acute neurologic disease in an intensive care unit (ICU) and compared it with the Glasgow Coma Scale (GCS) using 20 experienced and inexperienced neuroscience ICU nurses and nonneuroscience ICU nurses. Each nurse was trained with the use of video examples and instruction cards. Each patient was rated by 2 nurses, with the order randomly assigned. RESULTS The rater agreement was good to excellent with the FOUR score (weighted κ: eye, 0.84; respiration, 0.92; brainstem, 0.89; and motor, 0.73) and similar to that for the GCS (weightedκ: eye, 0.85; verbal, 0.89; and motor, 0.74). Greater average experience in years was associated with less disagreement, but the difference was not statistically significant. CONCLUSION The FOUR score provides more neurologic information than the GCS. The FOUR score can be used by any ICU nurses, even those with minimal experience.

Camille Chatelle - One of the best experts on this subject based on the ideXlab platform.

  • can the nociception Coma Scale revised be used in patients with a tracheostomy
    Archives of Physical Medicine and Rehabilitation, 2020
    Co-Authors: Steven Laureys, Camille Chatelle, Nicolas Lejeune, Aurore Thibaut, Geraldine Martens, Charlotte Martial, Sarah Wannez
    Abstract:

    Abstract Objective To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC). Design A cohort study in which patients were evaluated at a single time point. Setting Patients were evaluated in a tertiary care hospital. Participants Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age: 46±16y, time since injury: 817±1280d) in a convenience sample were evaluated with the NCS-R after noxious stimulation. Interventions Not applicable. Main Outcome Measures We compared the NCS-R scores of patients with and without tracheostomy with a Mann-Whitney U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cutoff score of 2. Results The presence of a tracheostomy was associated with lower verbal subscores (P=.002) as well as total scores (P=.039). The cutoff score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (sensitivity=83.2% and specificity=92.4%). Conclusion Our study confirms the validity of the NCS-R in DOC patients with a tracheostomy. However, the presence of a nonspeaking tracheostomy should be clearly mentioned when applying the NCS-R, because it significantly lowers the verbal subscore.

  • is the nociception Coma Scale revised a useful clinical tool for managing pain in patients with disorders of consciousness
    The Clinical Journal of Pain, 2016
    Co-Authors: Camille Chatelle, Steven Laureys, Marie Daniele De Val, Antonio Catano, Cristo Chaskis, Pierrette Seeldrayers, Patrick Biston, Caroline Schnakers
    Abstract:

    OBJECTIVES: Our objective was to assess the clinical interest of the Nociception Coma Scale Revised (NCS-R) in pain management of patients with disorders of consciousness. METHODS: Thirty-nine patients with potential painful conditions (e.g., due to fractures, decubitus ulcers or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient's clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment in order to observe fluctuations in consciousness. Twenty-three of them had no analgesic treatment prior to the assessment whereas the analgesic treatment has been adapted in the other 16 patients. We performed non-parametric Wilcoxon tests to investigate the difference in the NCS-R and GCS total scores but also in the NCS-R subscores before versus during treatment. The effect of the level of consciousness and the etiology were assessed using a U Mann Whitney. RESULTS: NCS-R total scores were statistically lower during treatment when compared to the scores obtained before treatment. We also found that the motor, verbal and facial expression subscores were lower during treatment than before treatment. On the other hand, we found no difference between the GCS total scores obtained before versus during treatment. DISCUSSION: Our results suggest that the NCS-R is an interesting clinical tool for pain management. Besides, this tool seems useful when a balance is needed between reduced pain and preserved level of consciousness in patients with disorders of consciousness. Language: en

Steven Laureys - One of the best experts on this subject based on the ideXlab platform.

  • can the nociception Coma Scale revised be used in patients with a tracheostomy
    Archives of Physical Medicine and Rehabilitation, 2020
    Co-Authors: Steven Laureys, Camille Chatelle, Nicolas Lejeune, Aurore Thibaut, Geraldine Martens, Charlotte Martial, Sarah Wannez
    Abstract:

    Abstract Objective To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC). Design A cohort study in which patients were evaluated at a single time point. Setting Patients were evaluated in a tertiary care hospital. Participants Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age: 46±16y, time since injury: 817±1280d) in a convenience sample were evaluated with the NCS-R after noxious stimulation. Interventions Not applicable. Main Outcome Measures We compared the NCS-R scores of patients with and without tracheostomy with a Mann-Whitney U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cutoff score of 2. Results The presence of a tracheostomy was associated with lower verbal subscores (P=.002) as well as total scores (P=.039). The cutoff score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (sensitivity=83.2% and specificity=92.4%). Conclusion Our study confirms the validity of the NCS-R in DOC patients with a tracheostomy. However, the presence of a nonspeaking tracheostomy should be clearly mentioned when applying the NCS-R, because it significantly lowers the verbal subscore.

  • is the nociception Coma Scale revised a useful clinical tool for managing pain in patients with disorders of consciousness
    The Clinical Journal of Pain, 2016
    Co-Authors: Camille Chatelle, Steven Laureys, Marie Daniele De Val, Antonio Catano, Cristo Chaskis, Pierrette Seeldrayers, Patrick Biston, Caroline Schnakers
    Abstract:

    OBJECTIVES: Our objective was to assess the clinical interest of the Nociception Coma Scale Revised (NCS-R) in pain management of patients with disorders of consciousness. METHODS: Thirty-nine patients with potential painful conditions (e.g., due to fractures, decubitus ulcers or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient's clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment in order to observe fluctuations in consciousness. Twenty-three of them had no analgesic treatment prior to the assessment whereas the analgesic treatment has been adapted in the other 16 patients. We performed non-parametric Wilcoxon tests to investigate the difference in the NCS-R and GCS total scores but also in the NCS-R subscores before versus during treatment. The effect of the level of consciousness and the etiology were assessed using a U Mann Whitney. RESULTS: NCS-R total scores were statistically lower during treatment when compared to the scores obtained before treatment. We also found that the motor, verbal and facial expression subscores were lower during treatment than before treatment. On the other hand, we found no difference between the GCS total scores obtained before versus during treatment. DISCUSSION: Our results suggest that the NCS-R is an interesting clinical tool for pain management. Besides, this tool seems useful when a balance is needed between reduced pain and preserved level of consciousness in patients with disorders of consciousness. Language: en

  • full outline of unresponsiveness compared with glasgow Coma Scale assessment and outcome prediction in Coma
    Critical Care, 2009
    Co-Authors: Didier Ledoux, Marieaurelie Bruno, S Jonlet, P Choi, Caroline Schnakers, Francois Damas, Bernard Lambermont, Pierre Damas, Steven Laureys
    Abstract:

    The most widely adopted Scale to assess consciousness in severely brain-damaged patients is the Glasgow Coma Scale (GCS) [1]. Its major shortcomings are the failure to assess the verbal component in intubated patients, the inability to test brainstem reflexes and breathing patterns. In 2005, Wijdicks and colleagues proposed a new Coma Scale, the Full Outline of Unresponsiveness (FOUR) Scale [2], which consists of four components (eye, motor, brainstem, and respiration), each component having a maximal score of 4. Our objective was to validate the French version of the new FOUR Coma Scale in a general ICU and to assess its predictive value as compared with the GCS.

Shahid Shafi - One of the best experts on this subject based on the ideXlab platform.

  • effect of alcohol on glasgow Coma Scale in head injured patients
    Annals of Surgery, 2007
    Co-Authors: Lance Stuke, Ramon Diazarrastia, Larry M Gentilello, Shahid Shafi
    Abstract:

    Objective: Almost 50% of traumatic brain-injured (TBI) patients are alcohol intoxicated. The Glasgow Coma Scale (GCS) is frequently used to direct diagnostic and therapeutic decisions in these patients. It is commonly assumed that alcohol intoxication reduces GCS, thus limiting its utility in intoxicated patients. The purpose of this study was to test the hypothesis that the presence of blood alcohol has a clinically significant impact on GCS in TBI patients. Methods: The National Trauma Data Bank of the American College of Surgeons was queried (1994‐2003). Patients 18 to 45 years of age with blunt injury mechanism, whose GCS in the emergency department, survival status, anatomic severity of TBI (Head Abbreviated Injury Score AIS), and blood alcohol testing status were known, were included. GCS of patients who tested positive for alcohol (n 55,732) was compared with GCS of patients who tested negative

  • usefulness of the abbreviated injury score and the injury severity score in comparison to the glasgow Coma Scale in predicting outcome after traumatic brain injury
    Journal of Trauma-injury Infection and Critical Care, 2007
    Co-Authors: Brandon Foreman, Shahid Shafi, Larry M Gentilello, Ruth R Caesar, Jennifer Parks, Christopher J Madden, Mary Carlile, Caryn R Harper, Ramon Diazarrastia
    Abstract:

    Background:Assessment of injury severity is important in the management of patients with brain trauma. We aimed to analyze the usefulness of the head abbreviated injury score (AIS), the injury severity score (ISS), and the Glasgow Coma Scale (GCS) as measures of injury severity and predictors of out

  • waiting for the patient to sober up effect of alcohol intoxication on glasgow Coma Scale score of brain injured patients
    Journal of Trauma-injury Infection and Critical Care, 2006
    Co-Authors: Jason L Sperry, Ramon Diazarrastia, Joseph P Minei, Randall S Friese, Larry M Gentilello, Shahid Shafi
    Abstract:

    Background:Between 35% to 50% of traumatic brain injury (TBI) patients are under the influence of alcohol. Alcohol intoxication may limit the ability of the Glasgow Coma Scale (GCS) to accurately assess severity of TBI. We hypothesized that alcohol intoxication significantly depresses GCS scores of

Claudia S Robertson - One of the best experts on this subject based on the ideXlab platform.

  • diagnosing level of consciousness the limits of the glasgow Coma Scale total score
    Journal of Neurotrauma, 2021
    Co-Authors: Claudia S Robertson, Brandon Foreman, Yelena G Bodien, Alice Barra, Nancy R Temkin, Jason Barber, Mary J Vassar, Sabrina R Taylor, Amy J Markowitz
    Abstract:

    In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured using the Glasgow Coma Scale (GCS) total score. However, the GCS total score may not accurately reflect level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS total scores and level of consciousness in a consecutive sample of 2,455 adult subjects assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We assigned each GCS subScale score combination a level of consciousness rating based upon published criteria for the following disorders of consciousness (DoC) diagnoses: Coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3-8=13%; 9-12=5%; 13-15=82%. All GCS total scores between 4-14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7-11. Furthermore, a wide range of total scores were associated with identical DoC diagnoses. Importantly, a diagnosis of Coma was only possible with GCS total scores of 3-6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subScale behaviors and more comprehensive assessments when evaluating TBI severity.

  • influence of alcohol on early glasgow Coma Scale in head injured patients
    Journal of Trauma-injury Infection and Critical Care, 2010
    Co-Authors: Hazem Shahin, Shankar P Gopinath, Claudia S Robertson
    Abstract:

    BACKGROUND:: To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time. METHODS:: The records of 269 head trauma patients consecutively admitted to the neurosurgery intensive care unit were examined retrospectively. Eighty-one patients were excluded because of incomplete data. The remaining 188 patients were further divided into an intoxicated group (blood alcohol concentration [BAC] ≥0.08%, n = 100 [53%]) and a nonintoxicated group (BAC Language: en

  • outcome in patients with blunt head trauma and a glasgow Coma Scale score of 3 at presentation
    Journal of Neurosurgery, 2009
    Co-Authors: Roukoz B Chamoun, Claudia S Robertson, Shankar P Gopinath
    Abstract:

    Object A Glasgow Coma Scale (GCS) score of 3 on presentation in patients with severe traumatic brain injury due to blunt trauma has been recognized as a bad prognostic factor. The reported mortality rate in these patients is very high, even approaching 100% in the presence of fixed and dilated pupils in some series. Consequently, there is often a tendency to treat these patients less aggressively because of the low expectations for a good recovery. In this paper, the authors' purpose is to report their experience in the management of this patient population, analyzing the mortality rate, prognostic factors, and functional outcome of survivors. Methods The authors performed a retrospective review of patients who presented between 1997 and 2007 with blunt head trauma and a GCS score of 3. Demographics, mechanism of injury, examination, blood alcohol level, associated injury, intracranial pressure (ICP), surgical procedures, and outcome were all recorded. Results A total of 189 patients met the inclusion cri...