Correlation between bispectral index and FOUR score in critically ill patients with traumatic brain injury: A cross-sectional study

Introduction For neurological testing and monitoring of traumatic brain injury (TBI) patients whose verbal component of the Glasgow Coma Scale (GCS) cannot be assessed, the Full Outline of Unresponsiveness (FOUR) score has been established. In order to determine the degree of awareness in patients with traumatic brain injury, this study will correlate the FOUR score with the bispectral index (BIS) and global consciousness score (GCS).Methods Twenty TBI patients with traumatic brain injury who were hospitalised to the surgical ICU at Cairo University Hospital participated in our prospective observational research. An observer who was blind to the BIS values assessed each of the FOUR scores and GCS (Covidien BIS complete monitoring system, Mansfield, MA, USA). Each patient provided four sets of readings. Spearman's correlation coefficient was used to perform a correlation between the FOUR score, GCS, and BIS (r).Results There was a significant correlation between BIS and FOUR score (r = 0.854, 95% confidence interval: 0.780-0.904) (P < 0.001). There was also a significant correlation between BIS and GCS (r = 0.864, 95% confidence interval: 0.795-0.911) (P < 0.001).Conclusion There is a strong correlation between FOUR score, GCS, and BIS values in patients with traumatic brain injury. FOUR score seems a reliable alternative for GCS and BIS in the assessment of degree of consciousness, especially in intubated patients.