Table 3.
Selected Prognostic Scales Commonly Used in Neurocritical Illness
| Condition | Prognostic Scale | Scoring | Outcome Measure(s) | Pros and Cons |
|---|---|---|---|---|
| Traumatic Brain Injury | Glasgow Coma Scale[17] | 3 (worst)-15 (best) | Mortality, functional outcome | Widely used and simple, but the verbal score cannot be assessed in intubated patients; and brainstem reflexes and breathing patterns are not assessed as part of the GCS. |
| FOUR Score[90] (Full Outline of Unresponsiveness) |
0 (worst)- 16 (best) | In-hospital mortality | Has good intra- and inter-rater reliability and distinguishes among patients with the lowest GCS scores. Not widely used, and predicts only mortality, not functional outcome. | |
| Marshall Classification of Head Injury on Head Computed tomography[91] | I-VI | Intracranial Pressure, functional outcome | Widely used and has been found to predict increased intracranial pressure and outcome, but focuses primarily on CT findings and does not incorporate exam or other prognostic factors. | |
| Subarachnoid Hemorrhage | Hunt-Hess Grade[20] | I (best)-V (worst) | Mortality, functional outcome | Commonly used in the U.S., the Hunt-Hess grade is one of the strongest predictors of outcome after subarachnoid hemorrhage. It does not distinguish well between moderately injured grade 3 patients. |
| World Federation of Neurological Surgeons Scale[94] | 1 (best)-5 (worst) | Mortality, functional outcome | Commonly used in Canada and Europe, WFNS combines the GCS score with the presence or absence of a major neurological deficit. It is similar to Hunt-Hess scale in predicting outcome.[148] Does not distinguish outcome well among grade III patients and there is variable application of what constitutes a “major neurological deficit”. | |
| Intracerebral Hemorrhage | ICH Score[18] | 0 (best)- 6 (worst) | Mortality | Widely used and simple scoring system. Focuses on mortality only and confounded by withdrawal. Not validated in a separate cohort. |
| FUNC Score[21] | 0 (worst)-11 (best) | Functional Outcome | Incorporates premorbid cognitive function and strongly predicts long term functional outcome. In multiple cohorts, no patient with a FUNC score ≤4 achieved functional independence, while >80% of patients with a FUNC score of 11 were functionally independent at 3-months. Not widely used. | |
| Anoxic Brain Injury | AAN prognostic guideline[149]* | Poor outcome predicted by: Myoclonus status epilepticus (24 hours) Absent SSEP N20 bilaterally (24-72 hours) NSE>33 μg/L (24-72 hours) Exam with absent pupil or corneal responses; extensor or no motor response (72 hours) |
Mortality, functional outcome | Provides a time based guideline for prognostication with low false positive rates at each step. Does not account for the improved outcomes with hypothermia/induced normothermia. Guidelines are nearly a decade old.[149] |
| Spinal Cord Injury | American Spinal Injury Association Scale (ASIA)[96] | A (worst)- E (best) | Motor and Sensory Function | The ASIA scale was not originally developed as a prognostic scale, but does correlate with functional outcome. [96] |
*
Applies to patients who have not undergone therapeutic hypothermia/induced normothermia.
ICH=intracerebral hemorrhage; AAN=American Academy of Neurology; SSEP=median somatosensory evoked potentials; NSE=neuronal specific enolase