A Useful New Coma Scale in Acute Stroke Patients: Four Score

Koçak, Yusuf; Öztürk, Şerefnur; Ege, Fahrettin; Ekmekçi, Hakan

doi:10.1177/0310057x1204000115

Cited by 16 publications

(30 citation statements)

References 29 publications

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“…However, their study addressed acute stroke including hemorrhagic stroke which had different mortality rates and patterns than ischemic stroke. 32 In the present results, when comparing three scores in predicting in hospital mortality collected one day and the third day of admission there was no difference between the NIHSS score, the GCS scale and the FOUR score. This is consistent with previous studies that found no significant differences between the effectiveness of the FOUR score and the GCS scale but the FOUR score is more accurate than the GCS in assessment more neurological examination and the depth of coma, Sacco et al 33 suggested that FOUR score is a reliable instrument to assess coma in stroke patients.…”

Section: Discussionsupporting

confidence: 39%

“…Kocak et al 32 found that ROC curve analysis showed significant trending with both FOUR score and GCS for prognosis; the area under curve for the FOUR score ranged from 0.675 to 0.922 when measurements had been made on day 3 and the area under curve for the GCS scale ranged from 0.62 to 0.82 when measurements had been made on day 3 suggest that FOUR score is a useful scale for evaluation of acute stroke patients in the intensive care unit as a homogeneous group, with respect to the outcome estimation, which is similar to the present results that found all sub-scores of the FOUR and the GCS at third day had a good predictive value for mortality.…”

Section: Discussionmentioning

confidence: 99%

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Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

Mansour

Megahed

Elghany³

2015

Alexandria Journal of Medicine

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Background: Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. No single outcome measure can describe or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials. Objectives: The aim of the work was to evaluate the FOUR score predictability for outcome of patients with acute ischemic stroke in comparison with the NIHSS and the GCS. Methods: 127 adult patients with acute ischemic stroke were enrolled. NIHSS, GCS, and FOUR score were collected at 24 and 72 h. Patients were prospectively followed up for the following outcomes; In-hospital or 30 days mortality and Modified Rankin Scale (mRS) at 3 months. The areas under receiver operating characteristic curve (AUC) were compared between the three scores. Results: Twenty-five (19.7%) patients died, and seventy-two (56.7%) had unfavourable outcome. The NIHSS, the GCS, and the FOUR score were not different in predicting in-hospital mortality (AUC: 0.783, 0.779, 0.975,. The NIHSS, the GCS, and the FOUR score done at 24-h were not different in predicting unfavourable outcome (AUC: 0.893, 0.868, and 0.865, respectively). However, the NIHSS done at 72-h showed significantly higher AUC than the GCS score (0.958 versus 0.931, p = 0.041), and higher than the Four score (0.958 versus 0.909, p = 0.011).

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Section: Discussionsupporting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

Mansour

Megahed

Elghany³

2015

Alexandria Journal of Medicine

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“…Since its introduction in 2005, the FOUR score has been investigated against the GCS and it was found to have a similar if not higher prediction of mortality and poor neurological outcome in general ICU population,[7111718] traumatic brain injury patients,[19202122] stroke patients,[23] and patient admitted after cardiac arrest. [2425] Concerns have been reported regarding the accuracy of using the GCS,[2627] especially in intubated ICU patients due to the impracticality of assessing the verbal response.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study

Said

Chaari

Hakim

et al. 2016

Int J Crit Illn Inj Sci

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Objective:To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS).Patients and Methods:All intubated critically ill patients with a disturbed level of consciousness were assessed using both the FOUR score and the GCS. The FOUR score and the GCS were compared regarding their predictive value for successful extubation at 14 days after intubation as a primary outcome measure. The 28-day mortality and the neurological outcome at 3 months were used as secondary outcome measures.Results:Eighty-six patients were included in the study. Median age was 63 (50–77) years. Sex–ratio (M/F) was 1.46. On admission, median GCS was 7 (3–10) while median FOUR score was 8.5 (2.3–11). A GCS ≤ 7 predicted the extubation failure at 14 days after intubation with a sensitivity of 88.5% and specificity of 68.3%, whereas a FOUR score <10 predicted the same outcome with a sensitivity of 80.8% and a specificity of 81.7%. The areas under the curves was significantly higher with the FOUR score than with GCS (respectively 0.867 confidence interval [CI]: 95% [0790–0.944] and 0.832 CI: 95% [0.741–0.923]; P = 0.014). When calculated before extubation, FOUR score <12 predicted extubation failure with a sensitivity of 92.3% and a specificity of 85%, whereas a GCS <12 predicted the same outcome with a sensitivity of 73% and a specificity of 61.7%. Both scores had similar accuracy for predicting 28-day mortality and neurological outcome at 3 months.Conclusion:The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients.

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“…In terms of outcome predictability, the FOUR score has been shown to be equivalent to the GCS (Kocak et al, ; McNett et al, ; Tadrisi et al, ) or even superior to the GCS in traumatic brain injury patients (Okasha, Fayed, & Saleh, ). Notably, the predictive power of the FOUR score has been reported to be far greater than the GCS in patients with severely impaired consciousness (GCS score <9; Chen et al, ; Kasprowicz et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…The validity of the FOUR score has been verified in traumatic brain injury or stroke (Chen, Grothe, & Schaller, 2013;Kasprowicz, Burzynska, Melcer, & Kübler, 2016;Kocak, Ozturk, Ege, & Ekmekci, 2012;McNett et al, 2014;Tadrisi, Bahari, Ebadi, & Madani, 2012), but not in spontaneous SAH. Because the FOUR score has the potential to become a standard measure of consciousness status, its validity and reliability in spontaneous SAH need to be determined.…”

Section: Introductionmentioning

confidence: 99%

Construct validity and reliability of the Full Outline of UnResponsiveness (FOUR) score in spontaneous subarachnoid haemorrhage caused by aneurysm rupture

Shin

Kim

et al. 2019

Journal of Clinical Nursing

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Aims and objectives This study aimed at examining the construct validity and reliability of the Full Outline of UnResponsiveness score in patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture. Background The Full Outline of UnResponsiveness score is known to be a valid and reliable consciousness assessment tool and provides comprehensive information not given by the Glasgow Coma Scale. However, the validity and reliability of this tool have not been tested in patients with spontaneous subarachnoid haemorrhage. Design A nonexperimental, descriptive, correlational study design was adopted. Methods The STROBE statement was used for reporting this study. The study participants were 72 patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture, admitted to an intensive care unit in a university hospital between August 2016–July 2017. Data on demographic characteristics, Hunt–Hess clinical stage scores, Fisher CT stage scores, disease‐related characteristics, Full Outline of UnResponsiveness scores and 1‐month Glasgow Outcome Scale scores were subjected to analysis. Results Full Outline of UnResponsiveness scores were found to have significant correlations with scores on Hunt–Hess clinical or Fisher CT stage tool and adequately predict 1‐month recovery. This tool also exhibited excellent inter‐rater agreement and internal consistency. Conclusions The Full Outline of UnResponsiveness score is valid and reliable for consciousness evaluation in spontaneous subarachnoid haemorrhage. It has been believed that use of this tool may help prevent negative consequences arising from impaired consciousness and improve the outcomes of patients with spontaneous aneurysmatic subarachnoid haemorrhage. Relevance to clinical practice The Full Outline of UnResponsiveness score is a consciousness assessment tool that provides more neurological detail because it includes consideration of brainstem reflexes, visual tracking, breathing patterns and respiratory drive, and can be applied in cases of spontaneous subarachnoid haemorrhage and other types of brain injury, especially in patients with severe consciousness impairment.

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A Useful New Coma Scale in Acute Stroke Patients: Four Score

Cited by 16 publications

References 29 publications

Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study

Construct validity and reliability of the Full Outline of UnResponsiveness (FOUR) score in spontaneous subarachnoid haemorrhage caused by aneurysm rupture

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