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Comparison of the Full Outline of UnResponsiveness Score and the Glasgow Coma Scale in Predicting Mortality in Critically Ill Patients*

Wijdicks, Eelco F.M. MD, PhD1; Kramer, Andrew A. PhD2; Rohs, Thomas Jr MD3; Hanna, Susan BS4; Sadaka, Farid MD5; O’Brien, Jacklyn RN5; Bible, Shonna MSN6; Dickess, Stacy M. BSN7; Foss, Michelle RN8

doi: 10.1097/CCM.0000000000000707
Neurologic Critical Care
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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.

1Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.

2Cerner Corporation, Vienna, VA.

3Department of Trauma and Emergency Surgery, Borgess Medical Center, Kalamazoo, MI.

4Department of Critical Care, Borgess Medical Center, Kalamazoo, MI.

5Department of Critical Care Medicine, Mercy Hospital, St. Louis, MO.

6Project Management/Quality, Spartanburg Regional Medical Center, Spartanburg, SC.

7Performance Improvement Department, St. Mary’s Medical Center, Huntington, WV.

8Intensive Care Unit, Shawnee Mission Medical Center, Shawnee Mission, KS.

* See also p. 505.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Kramer reports that he is an employee of Cerner Corporation, which holds the marketing rights to the Acute Physiology and Chronic Health Evaluation (APACHE) system. Part of the data for this study came from APACHE. However, this article does not promote APACHE; any electronic medical record system could have been used to generate the necessary data. Dr. Rohs Jr is employed by the Borgess Medical Center. Dr. Foss is employed by the Shawnee Mission Medical Center (Critical Care Data Coordinator). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: wijde@mayo.edu

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