ASSOCIATION OF AGE AND FOUR SCORE WITH ICU LENGTH OF STAY IN POST-CRANIOTOMY PATIENTS AT SAKINAH HOSPITAL MOJOKERTO
DOI:
https://doi.org/10.29082/IJNMS/2025/Vol9/Iss3/804Keywords:
FOUR Score, age, len gth of stay, postcraniotomyAbstract
This study aimed to analyze the association factors between age, FOUR Score, and ICU length of stay among post-craniotomy patients treated at Sakinah Hospital. A cross-sectional study was conducted from 01 October to 12 December 2025 involving adult post-craniotomy patients admitted consecutively to the ICU. Eligible participants were ≥18 years old, intubated postoperatively, and had a completed FOUR Score assessment. Fisher’s Exact Test and relative risk (RR) with 95% confidence intervals (CI) were applied to examine associations between age, FOUR Score, and ICU LOS. A significance level of p < 0.05 was used. 29 patients, 58.6% were aged ≥53 years and 62.1% experienced prolonged ICU stay. A FOUR Score ≤10 was observed in 58.6% of the cohort. Lower FOUR Scores were strongly associated with prolonged ICU stay (p < 0.000; RR = 9.7; 95% CI: 1.4–63.8). Older age also demonstrated a significant association with extended LOS (p = 0.018; RR = 2.47; 95% CI: 1–7.7). Both advanced age and lower FOUR Scores were significant associated with prolonged ICU stay among post-craniotomy patients. These findings underscore the utility of integrating neurological scoring with demographic risk profiling to support early prognostication and guide resource allocation in neurosurgical critical care.
Downloads
References
Agrawal, N., Iyer, S. S., Patil, V., Kulkarni, S., Shah, J. N., & Jedge, P. (2023a). Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India. Acute and Critical Care, 38(2), 226–233. https://doi.org/10.4266/acc.2023.00570
Agrawal, N., Iyer, S. S., Patil, V., Kulkarni, S., Shah, J. N., & Jedge, P. (2023b). Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India. Acute and Critical Care, 38(2), 226–233. https://doi.org/10.4266/acc.2023.00570
Almojuela, A., Hasen, M., & Zeiler, F. A. (2019). The Full Outline of UnResponsiveness (FOUR) Score and Its Use in Outcome Prediction: A Scoping Systematic Review of the Adult Literature. In Neurocritical Care (Vol. 31, Issue 1, pp. 162–175). Humana Press Inc. https://doi.org/10.1007/s12028-018-0630-9
Dasenbrock, H. H., Liu, K. X., Devine, C. A., Chavakula, V., Smith, T. R., Gormley, W. B., & Dunn, I. F. (2015). Length of hospital stay after craniotomy for tumor: A National Surgical Quality Improvement Program analysis. Neurosurgical Focus, 39(6). https://doi.org/10.3171/2015.10.FOCUS15386
Khanal, K., Bhandari, S. S., Shrestha, N., Acharya, S. P., & Marhatta, M. N. (2016). Comparison of outcome predictions by the Glasgow coma scale and the Full Outline of UnResponsiveness score in the neurological and neurosurgical patients in the Intensive Care Unit. Indian Journal of Critical Care Medicine, 20(8), 473–476. https://doi.org/10.4103/0972-5229.188199
Kurz, E., Kalasauskas, D., Wesp, D., Krenzlin, H., Schulze, A., Bulut, M., Kerz, T., Ringel, F., & Keric, N. (2025). Necessary Intensity of Monitoring After Elective Craniotomies: A Prediction Score for Postoperative Complications to Stratify Postoperative Monitoring. Neurocritical Care, 43(2), 484–492. https://doi.org/10.1007/s12028-025-02242-z
Lonjaret, L., Guyonnet, M., Berard, E., Vironneau, M., Peres, F., Sacrista, S., Ferrier, A., Ramonda, V., Vuillaume, C., Roux, F. E., Fourcade, O., & Geeraerts, T. (2017). Postoperative complications after craniotomy for brain tumor surgery. Anaesthesia Critical Care and Pain Medicine, 36(4), 213–218. https://doi.org/10.1016/j.accpm.2016.06.012
Nyam, T. T. E., Ao, K. H., Hung, S. Y., Shen, M. L., Yu, T. C., & Kuo, J. R. (2017). FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury. Neurocritical Care, 26(2), 225–231. https://doi.org/10.1007/s12028-016-0326-y
Perrella, A., Geen, O., Ahuja, M., Scott, S., Kaushik, R., Ferrante, L. E., Brummel, N. E., Muscedere, J., & Rochwerg, B. (2024). Exploring the Impact of Age, Frailty, and Multimorbidity on the Effect of ICU Interventions: A Systematic Review of Randomized Controlled Trials. Critical Care Medicine, 52(9), e463–e472. https://doi.org/10.1097/CCM.0000000000006315
Raaj Vishnu R, Dhilipan K, Prakash PS, & Selvarajan N. (2023). Comparative study of the diagnostic power of full outline of unresponsiveness score and Glasgow coma scale in patients with traumatic brain injury in an emergency department. Asian Journal of Medical Sciences, 14(12), 131–137. https://doi.org/10.3126/ajms.v14i12.57067
Ramazani, J., & Hosseini, M. (2022). Prediction of Mortality in the Medical Intensive Care Unit with Serial Full Outline of Unresponsiveness (FOUR) Score in Elderly Patients. Indian Journal of Critical Care Medicine, 26(1), 94–99. https://doi.org/10.5005/jp-journals-10071-24094
Rodrigues, A. R., Oliveira, A., Vieira, T., Assis, R., Lume, C., Gonçalves-Pereira, J., & Fernandes, S. M. (2024). A prolonged intensive care unit stay defines a worse long-term prognosis – Insights from the critically ill mortality by age (Cimba) study. Australian Critical Care, 37(5), 734–739. https://doi.org/10.1016/j.aucc.2024.03.001
Sangtongjaraskul, S., Lerdsirisopon, S., Sae-Phua, V., Kanta, S., & Kongkiattikul, L. (2023). Factors Influencing Prolonged Intensive Care Unit Length of Stay after Craniotomy for Intracranial Tumor in Children: A 10-year Analysis from A University Hospital. Indian Journal of Critical Care Medicine, 27(3), 205–211. https://doi.org/10.5005/jp-journals-10071-24418
Schey, J. E., Schoch, M., & Kerr, D. (2025). The Predictive Validity of the Full Outline of UnResponsiveness Score Compared to the Glasgow Coma Scale in the Intensive Care Unit: A Systematic Review. In Neurocritical Care (Vol. 43, Issue 2, pp. 645–658). Springer. https://doi.org/10.1007/s12028-024-02150-8
Suresh, V., Yaddanapudi, L., & Podder, S. (2019). Full Outline of UnResponsiveness score versus Glasgow Coma Scale in critically ill patients with altered sensorium: A comparison of inter-observer variability and outcomes. Indian Journal of Anaesthesia, 63(8), 640–647. https://doi.org/10.4103/ija.IJA_377_19
Vallet, H., Guidet, B., Boumendil, A., De Lange, D. W., Leaver, S., Szczeklik, W., Jung, C., Sviri, S., Beil, M., & Flaatten, H. (2023). The impact of age-related syndromes on ICU process and outcomes in very old patients. In Annals of Intensive Care (Vol. 13, Issue 1). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1186/s13613-023-01160-7
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Rudi Hariyono, Ika Ainur Rofi’ah
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with IJNMS agree to the following terms
- Authors retain copyright licensed under a Creative Commons Attribution-ShareAlike 4.0 International License that allows others to share the work non-commercially with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). Authors can archive pre-print and post-print or publisher's version/PDF.
How to Cite
_IJNMS.png)
