Comparison of GCS and four scoring system in prediction of mortality in ICU admitted patients.

Abstract

Objective: To determine diagnostic accuracy of GCS and FOUR score in predicting mortality keeping actual mortality as gold standard. Study Design: Cross Sectional (valudation) study. Setting: Department of Pediatrics, Children Hospital Faisalabad. Period: September, 2024 to March 2025. Methods: We included three hundred fifteen children with neurological disorders who were admitted to the pediatric intensive care unit (PICU). The GCS and FOUR score findings were documented as clinical examination evidence in the PICU. The FOUR score and GCS score were calculated for each patient. Responses were documented using clinical examination of ocular, motor, verbal and brain stem reflexes. Mortality was assessed over a 7-day follow-up period. Results: Patients' mean GCS and FOUR score at admission were 8.66±1.6 and 11.69±2.37, respectively, and the mean PICU stay was 6.57±2.33 days. The mean age 6.77±2.84 years. The proportion of male patients (54%) was greater than that of female patients (46%). One hundred one patients (32.1%) died. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate in predicting mortality using the Full Outline of Unresponsiveness Score (FOUR score) in children admitted to the PICU were 67.33%, 88.79%, 73.91%, 85.2%, and 81.9% respectively. On the other hand, GCS sensitivity, specificity, PPV, NPV, and accuracy rate are 63.37%, 84.58%, 65.98%, and 83.03%, respectively. Conclusion: The FOUR and GCS show good results with respect to mortality within a week after admission to the pediatric intensive care unit.