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Related Experiment Videos

Validation of a new coma scale: The FOUR score.

Eelco F M Wijdicks1, William R Bamlet, Boby V Maramattom

  • 1Division of Critical Care Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. wijde@mayo.edu

Annals of Neurology
|September 24, 2005
PubMed
Summary

The new FOUR (Full Outline of UnResponsiveness) score offers a more detailed neurological assessment than the Glasgow Coma Scale (GCS). This coma score showed excellent reliability and improved patient stratification, particularly for mortality risk.

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Area of Science:

  • Neurology
  • Critical Care Medicine
  • Neuroscience

Background:

  • The Glasgow Coma Scale (GCS) is widely used but has limitations, including failure to assess verbal scores in intubated patients and inability to test brainstem reflexes.
  • These shortcomings can lead to incomplete neurological assessments in critically ill patients.

Purpose of the Study:

  • To introduce and evaluate the FOUR (Full Outline of UnResponsiveness) score, a novel coma assessment tool.
  • To compare the performance and reliability of the FOUR score against the established GCS score in intensive care unit patients.

Main Methods:

  • A prospective study involving 120 intensive care unit patients was conducted.
  • The FOUR score, comprising eye, motor, brainstem, and respiration components (each maximal 4 points), was assessed by neuroscience nurses, neurology residents, and neurointensivists.

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  • Interrater reliability and agreement were compared between the FOUR score and the GCS.

    • Main Results:

    • The FOUR score demonstrated excellent interrater reliability (kappa(w) = 0.82), comparable to the GCS.
    • The FOUR score provided greater neurological detail, distinguishing patients with lower GCS scores and recognizing conditions like locked-in syndrome.
    • Higher in-hospital mortality probability was associated with the lowest total FOUR scores compared to the lowest GCS scores.

    Conclusions:

    • The FOUR score is a reliable and comprehensive tool for neurological assessment in critically ill patients.
    • It offers advantages over the GCS by incorporating brainstem reflexes, breathing patterns, and identifying herniation stages.
    • The FOUR score improves neurological detail and prognostic accuracy, especially in distinguishing mortality risk.