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Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study
Luis Idrovo1, Blanca Fuentes, Josmarlin Medina
1Department of Neurology, Stroke Unit, La Paz University Hospital, Autonoma University of Madrid, IdiPAZ, Madrid, Spain.
European Neurology
|June 17, 2010
Summary
The FOUR score reliably assesses consciousness in acute stroke patients, offering an alternative to the Glasgow Coma Scale (GCS) for those with communication or intubation challenges. This coma scale demonstrates excellent interobserver agreement.
Area of Science:
- Neurology
- Critical Care Medicine
- Clinical Neuroscience
Background:
- The Glasgow Coma Scale (GCS) is standard for assessing consciousness in acute stroke but has limitations, particularly for aphasic or intubated patients.
- The FOUR (Full Outline of UnResponsiveness) score offers a comprehensive assessment including eye, motor, brainstem reflexes, and respiration.
- Evaluating the interobserver variability of the FOUR score is crucial for its clinical adoption in acute stroke care.
Purpose of the Study:
- To assess the interobserver reliability of the FOUR score in patients with acute stroke.
- To compare the reliability of the FOUR score with the established Glasgow Coma Scale (GCS).
Main Methods:
- Prospective enrollment of consecutive acute stroke patients admitted to a neurology stroke unit.
- Paired evaluations of patients using the FOUR score and GCS by neurology residents and nurses.
- Calculation of weighted kappa values (Kw) and intraclass correlation coefficients (ICC) to determine interobserver agreement.
Main Results:
- Excellent overall rater agreement was observed for the FOUR score (Kw 0.93) and GCS (Kw 0.96).
- High intraclass correlation coefficients (ICC) indicated strong reliability for both scales (FOUR score: 0.94; GCS: 0.96).
- A significant positive correlation was found between the FOUR score and GCS (rho 0.83) and a negative correlation with the NIH stroke scale (rho -0.78).
Conclusions:
- The FOUR score is a reliable tool for assessing consciousness in acute stroke patients.
- The FOUR score demonstrates excellent interobserver agreement, comparable to the GCS.
- The FOUR score shows good correlation with both the GCS and NIH stroke scale, supporting its clinical utility.
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