Comparison of the Full Outline of UnResponsiveness Score and the Glasgow Coma Scale in Predicting Mortality in Critically Ill Patients*. Issue 2 (February 2015) - Wijdicks, Eelco F.M.
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. Abstract : Supplemental Digital Content is available in the text.