Ability of Glasgow Coma Scale and Full Outline of Unresponsiveness Score in Measuring Level of Consciousness and Outcome in Patients Receiving Sedation Under Mechanical Ventilation

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Background: Determining the level of consciousness is one of the main responsibilities of nurses in intensive care unit (ICUs). Scales used to determine the level of consciousness should be less affected by the injection of analgesics and sedatives and should provide proper vision of the patient’s status. Objectives: This study was conducted to assess the ability of two tools including Glasgow coma scale (GCS) and full outline of unresponsiveness (FOUR) score in measuring the level of consciousness and outcome in patients receiving sedation under mechanical ventilation. Methods: The present analytical descriptive study was conducted on 80 trauma patients receiving sedation under mechanical ventilation in 2016 in Zahedan, Iran. The patients having inclusion criteria were evaluated using the two tolls of GCS and FOUR score on admission and after starting and stopping sedation until the last days of hospitalization. The data were analyzed to assess the ability of the tools in measuring the level of consciousness after starting sedation and determine the outcome using independent t-test, chi-square test, and repeated measures ANOVA. Results: Of 80 patients studied, 61 were male (76.2 %) and the rest were female. Independent t-test results showed no significant association between the mean admission GCS score and mortality though the deceased patients obtained higher mean score (P = 0.978). Independent t-test revealed no significant association between the mean FOUR score on the first-day and mortality, though the deceased patients gained higher mean score (P = 0.578). The results of repeated measures ANOVA indicated that the mean GCS score after onset of sedative infusions reduced significantly compared to earlier (P = 0.001). This test also revealed that the mean FOUR score after onset of sedation decreased slightly than before although this reduction was not statistically significant (P = 0.432). Conclusions: According to fewer changes in FOUR score than the GCS score after starting and stopping sedation, it is more appropriate criterion for measuring the level of consciousness in trauma patients receiving sedation.