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Critical apraisal


By group 2
Title of journal

Comparison of Full Outline of

Unresponsiveness Score with Glasgow
Coma Scale in Determining Prognostic
Patients of Critical Pain

An awareness assessment is important in childhood

patients with critical pain to estimate prognosis.
Modification of Glasgow Coma Scale (GCS) is widely
used to assess awareness but has limitations especially
in intubated patients. There is a new alternative score
of Full Outline of UnResponsiveness score (FOUR score)
that can be used to assess awareness of the intubated

Comparing FOUR score with GCS in

determining the prognosis of critical patients,
so FOUR score check can be used as an
alternative to GCS

Population :
The population in this research is 30 people.
Respondents were selected based on inclusion and
exclusion criteria. As for the criteria of inkulusinya are
children aged less than 18 years with decreased
awareness and exclusion criteria Children with mental
development disorder, cerebral palsy, get sedation,
paralysis, not willing to be the subject of research, and
incomplete data.

intervention :

Intervention in the study was to compare FOUR score with GCS in

determining the prognosis of critical patients treated in Intensive
Care Unit of Children. After the FOUR score and GCS were assessed,
the patient was followed for up to 7 days of care at the Intensive
Care Unit of the Child whether there was an outbreak of death
within that time or the patient was considered alive when it was
transferred to the child care room. Thereafter compared both the
sensitivity and specificity and receiver operating characteristic
(ROC) of both scores to the outcome of death were deaths while
admitted to the Intensive Care Unit of the Child.

comparison :

It has been known that the scoring system has been widely
used, the Glasgow Coma Scale (GCS) or GCS modification
for children but has limitations. FOUR score can provide
more information than GCS with a four component
assessment: brain stem brain assessment, eye assessment,
broad-spectrum motor response, and abnormal breathing
patterns and breathing effort, with a 0-4 rating scale for
each component .

comparison next:

The FOUR score was created to meet the need for rapid and easy-
to-use scale assessment of neurologic signs in patients with
conscious loss. This scale ignores disorientation or delirium in
verbal assessment, but provides a good scoring ability for eye
movement, brainstem reflex, and respiratory effort in patients with
ventilators. Another advantage of FOUR score is that it can be used
in patients with acute metabolic disturbances, shock, or other
nonstructural brain damage because it can detect early awareness

Outcome :

The results of this study were to compare the

use of GCS with FOUR score, from this study
found that the use of FOUR score is more
effective in assessing patients in critical
condition and use of ventilator.
Application :

This research journal can be applied in emergency units

such as ICCU / ICU, and operating room. Given the
limitations possessed by GCS, the FOUR score is very
effective to replace it because it can be used to assess
the level of awareness of the patient in a critical
condition or is in the use of a respiratory helped