A Comparison Study of Acute Stroke Prognostication between Full Outline of UnResponsiveness Score Coma Scale, Glasgow Coma Scale and Glasgow Coma Scale-Pupils Score in Emergency Department, Siriraj Hospital
Keywords:
Acute stroke, Coma scoring system, Emergency department, PrognosticationAbstract
Introduction The consciousness scoring systems are good predictors for defining mortality in acute stroke. However, there is no study comparing between Full Outline of UnResponsiveness (FOUR), Glasgow Coma Scale (GCS), and Glasgow Coma Scale-Pupils (GCS-P) score.
Objectives To compare the accuracy of FOUR, GCS-P, and GCS scores for predicting in-hospital mortality. The other objectives are the prognostication of these scores for 30-day and 90-day mortality and poor neurological outcome.
Method The prospective cohort study was conducted in the emergency department of Siriraj Hospital, between August 2019 and October 2020. Acute stroke patients were evaluated by the scoring systems before definitive treatment. The telephone interview was done at 30 and 90 days after onset of acute stroke.
Results From 315 participants, 33 (10.47%) were died in the hospital. The best scoring system for predicting in-hospital mortality was the GCS-P score with the area under the curve (AUC) 0.932 (95% CI 0.885-0.976). The AUC of GCS and FOUR scores were 0.930 and 0.895 respectively. GCS-P score was also the best coma score for predicting the 30 and 90-day mortality (AUC of 0.913 and 0.891). Although there was a poor relationship between the Modified Rankin Scale, Cerebral Performance Score, and coma scoring systems, the patients with low GCS-P, GCS, or FOUR scores tended to have poor neurological outcomes.
Conclusion GCS-P score is the best prognostication for in-hospital, 30-day, and 90-day mortality in acute stroke patients in the emergency department.
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