Title : Can full outline of unresponsiveness tool supersede GCS? Are we ready for the change?
Abstract:
Accurate assessment and monitoring of level of consciousness is fundamental for prompt management and recognizing warning signs of deterioration. The aim of study was to compare the Glasgow coma scale (GCS) and full outline of unresponsiveness -FOUR score (FS) tool for neurological assessment and predicting functional outcome. 131 patients selected from two major teaching hospitals at middle eastern countries. Patients were assessed on admission, day 2 & 4 and evaluated using the Glasgow outcome tool on discharge. Results: Using the Glasgow outcome score in predicting outcome, the area under the curve (AUC) was 92% (CI- 95%, 0.870-0.975) for FS and 74.73 % (CI-95%, 0.825-0.951) for GCS. Conclusions: The FS tool is precise in predicting mortality than GCS.
Implications on Nursing: The nursing education and practice must be constructed on evidence reflected from nursing research. GCS has a been long standing tool used for neurological assessment which fails to recognize brain stem reflexes, evaluation of irregular breathing and localization of deficits in coma. FOUR score accurately identifies the above deficits which assists the nurses in early identification of deteriorating consciousness, recognize initial warning signs and provocatively intervene to prevent complications like hypoxic brain damages. The essential domains of nursing care involve assessment and identifying initial warning signs that enables the nurse to modify the care accordingly to prevent complications. Hence, our nursing education must integrate updated tools that will facilitate and empower the students to use advanced assessment strategies, management guidelines and protocols in practice for rendering holistic care. And with introduction of new concepts based on nursing research will advance nursing education to distinguished nursing practice. In addition, such new concepts will benefit nurse educators to build its own unique knowledge in nursing.
Audience Take Away Notes:
- To introduce the concept of FOUR score and identify the advantages over the GCS tool
- To enable the audience in the application of FOUR score tool among patients with varied level of consciousness and different types of coma
- To assess the inter- rater reliability and accuracy in scoring among the audience with the use of FOUR score
