Validation of the Chinese version of the FOUR score in the assessment of neurosurgical patients with different level of consciousness

Abstract

BackgroundThe Glasgow Coma Scale (GCS) is currently the most widely used scoring system for comatose patients. A decade ago, the Full Outline of Unresponsiveness (FOUR) score was devised to better capture four functional aspects of consciousness (eye, motor responses, brainstem reflexes, and respiration). This study aimed to validate the Chinese version of the FOUR score in patients with different levels of consciousness.MethodsThe study had two phases: (1) translation of the FOUR score, and (2) assessment of its reliability and validity. The Chinese version of the FOUR score was developed according to a standardized protocol. One hundred-twenty consecutive patients with acute brain damage, admitted to Nanfang Hospital (Southern Medical University, Guangdong, China) from November 2014 to February 2015, were enrolled. The inter-rater agreement for the FOUR score and GCS was evaluated using intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were established to determine the scales’ abilities to predict outcome.ResultsThe rater agreement was excellent both for FOUR (ICC = 0.970; p < 0.001) and GCS (ICC = 0.958; p < 0.001). The FOUR score yielded an excellent test-retest reliability (ICC = 0.930; p < 0.001). Spearman’s correlation coefficients between GCS and the FOUR score were high: r = 0.932, first rating; r = 0.887, second rating (all p < 0.001). Areas under the curve (AUC) for mortality were 0.834 (95 % CI, 0.740–0.928) and 0.815 (95 % CI, 0.723–0.908) for the FOUR score and GCS, respectively.ConclusionsThe Chinese version of the FOUR score is a reliable scale for evaluating the level of consciousness in patients with acute brain injury.

A comparison between the effectiveness of full outline of unresponsiveness and glasgow coma score at neurosurgical intensive care unit patients

“…In this study, where GCS and FOUR scores have been compared in brain tumor or head trauma patients at the intensive care unit, we found that the FOUR score is as effective and trustworthy as GCS. Other reports also reveal the same thing as our study (1,4,(7)(8)(9)13).…”

“…Also correlation for both scales was quite strong. Other studies have stated that coefficient of concordance and correlation between practitioners were high as in our work (5,7,9,10,(12)(13)(14). This conclusion is thought to be helpful for decreasing mistakes when evaluating intensive care unit patients and a more accurate evaluation can be made.…”

“…However, there is no objective value such as body temperature or blood pressure to evaluate intensive care unit comatose patients, and therefore different scales are used (10). One of these scales is Glasgow Coma Score (GCS), which is known worldwide and commonly used to predict the level of, consciousness, mortality and morbidity (4,9,10,13). Even Different scoring systems have therefore been developed to evaluate patients in time (3,9).…”

“…One of these scores is the Full Outline of Unresponsiveness (FOUR) Score that was developed by Wijdicks et al in 2005 (3,4,9,13,16). There are 4 headers (eye response, motor response, brainstem reflexes, respiration) and scores from 0 to 4, to evaluate patients with FOUR which was recommended by the European Society of Intensive Care Medicine (ESICM) (3,4,9,13). Therefore using the FOUR score ensures that brainstem reflexes, respiration pattern and verbal response that are supplementary data for patient evaluation, absent in GCS, can be used (3,4,9).…”

Can Reflux Symptom Index and Reflux Finding Score Be Used to Guide the Treatment of Secretory Otitis Media in Adults?

“…The etiology of secretory otitis media in adults is complex and related to many factors [5]. Laryngopharyngeal reflux disease (LPRD), pharyngitis, sinusitis, and respiratory dysfunction are common predisposing factors [6][7][8]. Animal models have confirmed that gastric contents can cause inflammation in the throat and nasal cavity, and can reach the tympanum through the eustachian tube [9].…”