Endorsement of the FOUR Score for Consciousness Assessment in Neurosurgical Patients

Abstract

The Full Outline of UnResponsiveness (FOUR) score was previously developed for neurological assessment, but has not been validated in neurosurgical patients, so was compared to the Glasgow Coma Scale (GCS) in practice. Four groups of raters, expert clinicians, novice clinicians, experienced nurses, and inexperienced nurses, assessed 64 patients in awake, drowsy, stuporous, and comatose conditions to investigate rater reliability. Then, 36 patients were evaluated by 1 expert clinician and 1 from the other groups randomly to test the difference. Spearman's correlation was used to find the correlation between both scores from 68 patients. The estimation of FOUR score cut points was validated by weighted kappa compared with the GCS to establish the risk prognosis. Score feasibility was analyzed by nonparametric test. Intraclass correlation in each group was over 0.9, with no difference between expert and inexperienced raters (p À 0.05). The correlation was 0.78. Low, intermediate, and high risk prognosis were associated with 0-7, 8-14, and 15-16 FOUR scores with kappa of 0.92. The feasibility of the FOUR score was lower than that of the GCS (p º 0.01). The FOUR score is reliable and valid for consciousness evaluation with some consequences for practicability. Extensive implementation would increase familiarity.

Penilaian Kesadaran pada Anak Sakit Kritis: Glasgow Coma Scale atau Full Outline of UnResponsiveness score?

“…Pemeriksaan terhadap posisi tangan telah divalidasi sebelumnya dan dianggap reliabel untuk mendeteksi perubahan kesadaran sangat minimal. [13][14][15] Pemeriksaan refleks batang otak dapat membantu dalam penilaian kedalaman koma yang lebih lengkap dan akurat. Pemeriksaan fungsi batang otak, seperti refleks cahaya pupil, refleks kornea, dan refleks batuk dapat menilai fungsi mesensefalon, pons, medula oblongata, dan saraf okulomotor.…”

“…Refleks batuk hampir selalu menghilang bila refleks pupil dan kornea telah menghilang. 13 Pola napas Cheyne-Stokes dan ireguler dapat mencerminkan adanya disfungsi bihemisfer atau batang otak bagian bawah yang mengendalikan pernapasan, dan berhubungan dengan prognosis buruk. Pada pasien yang terintubasi, jumlah frekuensi napas yang melebihi frekuensi yang diberikan oleh mesin menggambarkan masih adanya fungsi pusat pernapasan atau usaha napas.…”

Predicting the outcome of children with head trauma: Comparison of FOUR score and GCS

“…It was developed by Wijdicks et al, [4] and further validations of this scale were done by other researches. [5][6][7][8][9][10] It is composed of eye, motor, brainstem, and respiration responses with a scale of 0-4 (0=worst, 4=best) as demonstrated in Table 1. The FOUR score specifically distinguishes certain unconsciousness states, provides important details such as brainstem reflexes, and includes the minimal necessities of neurological testing in altered mental status.…”

Sensitivity and Specificity of Full Outline of Unresponsiveness Score and Glasgow Coma Scale towards Patients’ Outcomes at the Intensive Care Units

“…GCS components were unable to facilitate the assessment on patients with locked syndrome. 9,10 A new instrument was made to complete the GCS instrument which still has some shortcomings, and it is called Unresponsiveness Score (FOUR score).…”

“…The result of the study showed different sensitivity and specificity scores with different cut off score as well. 9,11,12 . An alternative instrument to assess level of consciousness is needed in order to fill the limitations of GCS components.…”