Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness

Chen, Bixia; Grothe, Cibele; Schaller, Karl

doi:10.1007/s00701-013-1854-2

Cited by 33 publications

(51 citation statements)

References 32 publications

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“…FOUR better classifies level of consciousness damage in emergency patients (15,16), cardiac arrest patients (8), and ICU patients (12) compared to other scales. Furthermore, FOUR has greater validity and reliability among nurses, neurologists, and doctors (5,6,11,20). In the present study, FOUR showed high predicting value for in-hospital mortality, which agreed with Sadaka study (19).…”

Section: █ Resultsmentioning

confidence: 99%

“…Brain stem reflexes facilitate assessment of midbrain, pons and medulla oblongata functioning (18). This scale assesses various levels of damage to brain stem, and provides more accurate clinical prognosis for patient outcomes (5). Meanwhile, these are not examined in GCS scale.…”

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confidence: 99%

“…Impaired brain stem reflexes due to brain injuries alter respiratory pattern, and the need for mechanical ventilation can reflect intensity of coma (20). Therefore, neurological changes are not correctly and accurately assessed in GCS scale (5). In recent decades, different alternative scales to GCS have been proposed, which have not found widespread acceptability because of complexity of use (6).…”

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confidence: 99%

“…Full Outline of UnResponsiveness (FOUR) scale was proposed by Wijdicks et al for assessment of neurology patients with traumatic and non-traumatic impairments of the central nervous system. FOUR scale consists of 4 items, including: eye response, motor response, brain stem reflexes, and respiratory condition, each scoring from 0 to 4 (Appendix) (5). As opposed to GCS, eye response in FOUR, as well as open eyes, also assesses their voluntary movements, which distinguishes between vegetative state of patients and minor impaired level of consciousness (10,18).…”

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confidence: 99%

See 3 more Smart Citations

Glasgow coma scale versus full outline of unresponsiveness scale for prediction of outcomes in patients with traumatic brain injury in intensive care unit

Sepahvand¹,

Jalali²,

Mirzaei³

et al. 2015

Turkish Neurosurgery

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Section: █ Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Glasgow coma scale versus full outline of unresponsiveness scale for prediction of outcomes in patients with traumatic brain injury in intensive care unit

Sepahvand¹,

Jalali²,

Mirzaei³

et al. 2015

Turkish Neurosurgery

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“…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.…”

Section: Komponen Penilaian Pada Four Scoreunclassified

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

Dewi

2016

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Pemeriksaan neurologis tingkat kesadaran sangat penting untuk menilai secara komprehensif pasien anak sakit kritis, dan dapat memberikan informasi prognosis. Skala koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala koma telah dikembangkan dan di validasi untuk mengevaluasi tingkat kesadaran secara cepat, menilai beratnya penyakit dan prognosis terhadap morbiditas dan mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan baku emas saat memvalidasi skala koma yang baru. GCS mempunyai keterbatasan karena pasien yang terintubasi tidak dapat dinilai komponen verbal sehingga memengaruhi hasil penilaian. FOUR Score dikembangkan untuk mengatasi berbagai keterbatasan yang dimiliki GCS. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien-pasien yang terintubasi. Sari Pediatri 2016;17(5):401-6. Kata kunci: Glasgow Coma Scale, Full Outline of UnResponsiveness score, anak sakit kritis Review article Assessment of Consciousness in Critically Ill Children: Glasgow Coma Scale or Full Outline of UnResponsiveness Score? Rismala DewiNeurological evaluation of level of consciousness is very important to assess comprehensively in critically ill children, and may provide prognostic information. An ideal coma scale would be linear, reliable, valid, and easy to use. Various kinds of coma scale were developed and validated to rapidly evaluate level of consciousness, assess the severity of the disease and prognosis for morbidity and mortality. Glasgow Coma Scale (GCS) has remained as ''gold standard'' for assessing impaired consciousness, and it is frequently used to validate new coma scales. However, GCS has several shortcomings due to limitation to assess verbal component of intubated patients, thus may affect the results. FOUR Score was developed to overcome those limitations. Compared to GCS, FOUR score is simpler and provide better information, especially in intubated patients. Sari Pediatri 2016;17(5):401-6.

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Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale

Anestis

Marinos

Tsitsopoulos

2023

Eur J Trauma Emerg Surg

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Background Various tools simpler than the Glasgow Coma Scale (GCS) have been proposed for the assessment of consciousness. In this study, the validity of three coma scales [Simplified Motor Scale, Modified GCS Motor Response, and AVPU (alert, verbal, painful, unresponsive)] is evaluated for the recognition of coma and the prediction of short- and long-term mortality and poor outcome. The predictive validity of these scales is also compared to the GCS. Methods Patients treated in the Department of Neurosurgery and the Intensive Care Unit in need of consciousness monitoring were assessed by four raters (two consultants, a resident and a nurse) using the GCS. The corresponding values of the simplified scales were estimated. Outcome was recorded at discharge and at 6 months. Areas Under the Receiver Operating Characteristic Curve (AUCs) were calculated for the prediction of mortality and poor outcome, and the identification of coma. Results Eighty-six patients were included. The simplified scales showed good overall validity (AUCs > 0.720 for all outcomes of interest), but lower than the GCS. For the identification of coma and the prediction of long-term poor outcome, the difference was significant (p < 0.050) for all the ratings of the most experienced rater. The validity of these scales was comparable to the GCS only in predicting in-hospital mortality, but without this being consistent for all raters. Conclusion The simplified scales showed inferior validity than the GCS. Their potential role in clinical practice needs further investigation. Thus, the replacement of the GCS as the main scale for consciousness assessment cannot be currently supported.

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Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness

Abstract: The FOUR score was more robust than the GCS in predicting mortality after 30 days in neurosurgical patients with severely impaired consciousness. There was no relevant difference in predicting poor and good outcome.

Cited by 33 publications

References 32 publications

Glasgow coma scale versus full outline of unresponsiveness scale for prediction of outcomes in patients with traumatic brain injury in intensive care unit

Glasgow coma scale versus full outline of unresponsiveness scale for prediction of outcomes in patients with traumatic brain injury in intensive care unit

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

Comparison of the prognostic validity of three simplified consciousness assessment scales with the Glasgow Coma Scale

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