الفهرس 
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Abstract
Even though, within 40 years since its introduction, the GCS has stayed the cornerstone of initial traumatic brain injury evaluation by out-of-hospital personnel, emergency physicians, trauma surgeons, and neurosurgeons, on the basis of the findings of this study and considering the results of the previous studies, the FOUR scale appears to be an easier tool to use plus it provides a more comprehensive neurological assessment.
In current ICUs, multiple scores are frequently used. Preferably, these scores should be simple, reliable, and predictive for relevant outcomes and/or relevant clinical decisions. The widespread adoption of such a tool may heighten the ability to accurately forecast survivability, impacting the treatment and management of these patients and their families.
The present study aimed to:
1. Assess discharge outcomes in patients with traumatic brain injury by using Glasgow Coma Scale.
2. Assess discharge outcomes in patients with traumatic brain injury by using the full outline of Unresponsiveness Scale.
3. Compare between the full outline of Unresponsiveness Scale and the Glasgow Coma Scale in predicting discharge outcomes in patients with traumatic brain injury to find the most measurable one.
Research Design: A comparative research design was used in carrying out this study.
Setting of the study:
The study conducted at Neurosurgery Intensive Care Unit (ICU) in Al Fayoum University Hospital.
Subjects of the study:
A purposive sample of 100 adult patients with TBI were tested for their conscious level by the two scale (GCS and full outline of Un-Responsiveness Scale). Patients with TBI were included in the study, regardless of their age, sex, and type of trauma.
Inclusion criteria:
Age over 20 and below 65 years, diagnosed with TBI, in their first 24 hours of admission.
Exclusion criteria:
• Spinal cord injury
• neurosurgical patients
• Heavily sedated Patients or receiving neuromuscular function blockers.
• Patient with uncontrolled diabetes or have severe uremia or in end stage liver disease
Tools of Data Collection:
Data for this study were collected by using Three tools Tool I: “Patients Profile Data Form”, Tool II: “Level of Consciousness Assessment” and Tool III: “Discharge Data Assessment Record”.
Tool I: “Patients Profile Data Form”: It was include age, gender, reason of referral, mechanism of trauma, CT scan findings and it developed by investigator.
Tool II: “Level of Consciousness Assessment”
Glasgow Coma Scale: The GCS was developed by (Teasdale and Jennett, 1974) and (Teasdale and Jennett, 1976) and used to assess level of consciousness of patients. It is composed of three categories: Eye opening, verbal response, and motor response. The score from each category is summed to provide a total GCS score (range = 3-15).
Full Outline of Unresponsiveness scale is composed of four categories eye response, motor response, brain stem reflexes and respiration, where patients are assigned a score ranging from 0 to 4. Total scores from each category are summed (range = 0-16) (Wijdicks, Bamlet, Maramattom, Manno, and McClell and, 2005).
Tool III: “Discharge Data Assessment Record” To assess outcomes of patients with TBI and it was include length of stay in hospital, mortality, clinical diagnosis of brain death, motor disability, sensory impairment, and full recovery without any squeal at the time of discharge and it developed by investigator.
The result of the study revealed that:
• GCS is superior to FOUR score in prediction of length of stay.
• They are the same in prediction of motor disability and sensory impairment (physical impairment).
• FOUR score is superior to GCS in prediction of mortality and full recovery without any squeal.
The study recommended the following:
To train ICU nurses on how to assess traumatic brain injury patients.
To train ICU nurses on how to use GCS and FOUR score.
To put FOUR score instructions into ICU procedure book.