ASSOCIATION OF AGE AND FOUR SCORE WITH ICU LENGTH OF STAY
IN POST-CRANIOTOMY PATIENTS AT SAKINAH HOSPITAL
MOJOKERTO
Rudi Hariyono1.
Ika Ainur RofiAoah2.
Universitas Bina Sehat PPNI Mojokerto Corresponding Email: rudihariyono86@gmail.
ABSTRACT
Keywords 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.
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 Ou18 years old, intubated postoperatively, and had a completed FOUR Score assessment.
FisherAos 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.
were aged Ou53 years and 62.
1% experienced prolonged ICU stay.
A FOUR Score O10 was observed in 58.
6% of the cohort.
Lower FOUR Scores were strongly associated with prolonged ICU stay .
< 0.
RR = 9.
95% CI: 1.
4Ae63.
Older age also demonstrated a significant association with extended LOS .
= 0.
RR = 2.
CI: 1Ae7.
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 FOUR Score.
gth of stay.
INTRODUCTION Craniotomy is a fundamental surgical conditions, such as traumatic brain injury, brain tumors, and vascular malformations (Lonjaret et al.
, 2.
Despite improvements in surgical and perioperative care, patients who undergo craniotomy remain at significant risk for neurological deterioration, making close monitoring in the intensive care unit (ICU) essential to optimize outcomes and reduce morbidity and mortality (Kurz et al.
, 2.
The clinical profile and prognosis of these patients are shaped by multiple factors, including age, underlying pathology, comorbidities, and the complexity of the surgical procedure, all of which can influence the length of ICU stay and overall recovery (Dasenbrock et al.
, 2.
Accurate and timely neurological assessment in the ICU is crucial for early International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 detection of complications such as cerebral edema, hemorrhage, seizures, and delayed The Glasgow Coma Scale (GCS) has long been the standard tool for evaluating consciousness in neurocritical care, but it has notable limitations, especially in intubated or sedated patients, as it may not fully capture the spectrum of neurological function (Agrawal et al.
, 2023.
To address these limitations, the Full Outline of UnResponsiveness (FOUR) Score was developed, incorporating four domains : eye response, motor response, brainstem reflexes, and respiration, allowing particularly in patients who are intubated or have impaired verbal responses (Raaj Vishnu R et al.
, 2.
Recent studies and systematic reviews have shown that the FOUR Score provides prognostic value comparable to or slightly better than the GCS in various neurocritical populations, including those with traumatic brain injury and post-neurosurgical states.
Both tools demonstrate good to excellent accuracy in predicting mortality, with area under the curve (AUC) values often above 0,87 and both are associated with ICU length of stay and functional outcomes (Schey et , 2.
The FOUR Score capabilities to assess brainstem reflexes and respiratory patterns is particularly advantageous in the ICU, where many post-craniotomy patients require mechanical ventilation (Khanal et al.
, 2.
However, there is still limited data specifically characterizing the clinical profile of post-craniotomy patients in the ICU as assessed by the FOUR Score, especially across different healthcare settings and age groups (Suresh et al.
, 2.
Age is a well-established determinant of outcomes in neurocritical care, with older patients generally experiencing longer ICU stays, higher complication rates, and poor functional recovery following craniotomy (Sangtongjaraskul et al.
, 2.
The neurological status as measured by the FOUR Score (Nyam et al.
, 2.
, and ICU length of stay represents an important area for further research to inform risk stratification and optimize resource allocation in neurocritical care settings (Sangtongjaraskul et al.
, 2.
Despite growing evidence supporting the prognostic utility of the FOUR Score in diverse neurocritical care populations, several important gaps remain in the current Most existing studies have focused on heterogeneous cohorts, such as neurosurgical patients, with outcomes primarily centered on mortality or shortterm neurological status rather than ICU length of stay as a clinically meaningful resource-related outcome (Nyam et al.
, 2017
Schey et al.
, 2.
Consequently, data specifically examining post-craniotomy patients, a group with distinct perioperative risks and recovery trajectories remain Furthermore, although age has consistently been identified as a key determinant of adverse outcomes and prolonged ICU hospitalization after neurosurgical procedures, few studies have explored the combined relationship between age, level of consciousness as measured by the FOUR Score, and ICU length of stay within a single analytical framework (Sangtongjaraskul et al.
, 2.
Prior research has often evaluated these variables in isolation, thereby limiting their applicability for comprehensive risk assessment in routine ICU practice.
Additionally, distribution of clinical characteristics, such as primary diagnosis, comorbidities, and perioperative are factors among postcraniotomy patients, can provide valuable insights for ICU management protocols and improving patient outcomes (Kurz et al.
The aim of cross-sectional study to identify patterns and associations among patient age.
FOUR Score, and length of ICU on post-craniotomy patients admitted to the ICU at Sakinah Hospital.
Given the increasing global burden of neurosurgical diseases and the growing demand for critical care resources, there is a pressing need for robust, context-specific data on the clinical trajectories of post-craniotomy patients in the ICU.
Cross sectional studies are vital for International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 elucidating these patterns, identifying gaps in care, and guiding future interventional By systematically profiling postcraniotomy patients using the FOUR Score, research can contribute to the evidence base supporting optimal neurocritical care practices and highlight key factors were associated with ICU length of stay and patient outcomes.
METHOD
The type of research used is a crosectional survey.
The study was conducted at the Sakinah Hospital in OctoberAe December 2025.
The research population is adult patients who underwent craniotomy and were admitted to the ICU during the study period.
A consecutive sampling approach was employed, including all eligible patients who met the inclusion Inclusion criteria are aged Ou 18 years, intubated, admitted to the ICU after surgery, completed neurological assesement using FOUR Score.
The variables in this study were FOUR Score and age as independent variables.
ICU length of stay as dependent variables.
The instrument uses an Full Outline UnResponsiveness (FOUR).
Data were analyzed using SPSS version 21 (IBM Corp.
Armonk.
NY).
Descriptive statistics were applied to summarize patient characteristics.
Categorical variables were presented as frequencies and percentages.
ROC curve analysis revealed that age Ou53 years (AUC = 95% CI: 0.
60Ae0.
FOUR Score O10 (AUC = 0.
95% CI: 0.
68Ae0.
, and ICU length of stay Ou3 days (AUC = 0.
95% CI:
70Ae0.
provided optimal sensitivity and specificity for identifying patients at risk of prolonged ICU stay following craniotomy.
These findings indicate acceptable to good discriminatory power of the proposed Bivariate analysis using FisherAos exact test .
s appropriat.
with Relative Risk was employed to examine associations between independent variables (FOUR Score.
Ag.
and ICU LOS.
Variables with p < 0.
25 in bivariate analysis to estimate Relative ratios (RR) and 95% confidence intervals (CI).
Statistical significance was set at p < 0.
RESULTS
Table 1.
Respondents' Frequency Distribution Based on FOUR Score.
Age and Length of stay Hospital.
Variabels FOUR Score value O 10
> 10
Age Ou 53 years < 53 years Length of stay Long stay Short stay Based on the table 1, the majority of post-craniotomy patients admitted to the ICU of Sakinah Hospital, 58,6% were aged more than 53 years old, while younger than 53 years accounted for 41,4%.
Most patients experienced a prolonged ICU stay, representing 62,1%, whereas 37,9% patients with a shorter length of stay.
Regarding the FOUR Score, 58,6% of patients had a score O10, while 41,4% had a score > 10.
Table 2.
Crosstabulation of FOUR Score and Age on Length of stay among postcraniotomy patients at ICU at Sakinah
Hospital Length of stay
Long
Short
F %
O 10
> 10
Ou 53
< 53
Variabels p-value and Relative risk
FOUR
Score p-value =0,000 RR = 9,7.
95% CI .
Ae 63,.
Age p-value = 0,018 RR = 2,47.
95%CI .
Ae 7,.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 FisherAos Exact Test showed that length of stay was significantly associated with both FOUR Score value .
= 0,.
and length of stay .
= 0,.
Patients with lower FOUR Scores were nearly 10 times more likely to experience prolonged ICU stay (RR = 9,7.
95% CI: 1.
4Ae63,.
and required a longer age (RR= 2,47.
95% CI: 1Ae 7,.
DISCUSSION