Prediction of Mortality in the Medical Intensive Care Unit with Serial Full Outline of Unresponsiveness Score in Elderly Patients

BACKGROUND: Advanced age is one of the key risk factors for mortality and morbidity in intensive care units. The full outline of unresponsiveness (FOUR) score has been developed and introduced to address the limitations of the Glasgow Coma Scale (GCS). The current study aimed to evaluate the ability of the FOUR score in predicting the outcomes (survivors, nonsurvivors). MATERIALS AND METHODS: This observational study of 168 consecutive elderly patients admitted to medical intensive care during the 14 months carried out prospectively. FOUR score in the 24, 48, and 72 hours of admission, and demographic characteristics of all elderly patients were calculated, then recorded. The receiver operating characteristic (ROC) curve, logistic regression, and Hosmer-Lemeshow test were used (95% confidence interval) for statistical analysis. RESULTS: FOUR scores in 24, 48, and 72 hours between survivors and nonsurvivors (p <0.0001, p <0.0001, and p <0.0001, respectively) were statistically different. The discrimination power of FOUR score 24 hours of admission was excellent [area under ROC (AUC): 85.7% [standard error (SE)]: 2.8%]; it was acceptable for 48 and 72 hours of admission [AUC: 76.3% (SE: 3.6%), AUC: 75/0% (SE: 3.8%), respectively]. The FOUR score of 24 and 48 hours (x(2) = 10.06, p = 0.261, x(2) = 6.82, p = 0.448, respectively) showed acceptable calibration. CONCLUSIONS: The FOUR score is a suitable scoring system for prognostication of outcomes in critically ill elderly patients. The FOUR score 24 hours of admission was superior in terms of discrimination power than 48 and 72 hours, but better calibration power belonged to FOUR score 48 hours. HOW TO CITE THIS ARTICLE: Ramazani J, Hosseini M. Prediction of Mortality in the Medical Intensive Care Unit with Serial Full Outline of Unresponsiveness Score in Elderly Patients. Indian J Crit Care Med 2022;26(1):94–99.