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A pediatric FOUR score coma scale: interrater reliability and predictive validity.

Brianna L Czaikowski¹, Hong Liang, C Todd Stewart

¹Questions or comments about this article may be directed to Brianna L. Czaikowski, RN, at czaikowski.brianna@ministryhealth.org. She is a Registered Nurse in the Pediatric Intensive Care Unit, Ministry St. Joseph's Hospital, Marshfield, WI. Hong Liang, PhD, is a Biostatistician in the Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI. C. Todd Stewart, MD, was the Vice President and a Pediatric Intensivist at Marshfield Clinic/Ministry St. Joseph's Hospital, Marshfield, WI.

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|February 22, 2014

Summary

This summary is machine-generated.

The Pediatric FOUR Score Scale (PFSS) shows excellent reliability for assessing critically ill children, including those sedated or intubated. While not significantly different from the Glasgow Coma Scale (GCS), the PFSS offers potential for improved neurological assessment in this population.

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Area of Science:

Neurology
Pediatric Critical Care

Background:

The Full Outline of UnResponsiveness (FOUR) Score is a validated coma scale for adults and children.
Existing scales like the Glasgow Coma Scale (GCS) have limitations in assessing intubated or sedated pediatric patients.

Purpose of the Study:

To modify and evaluate the FOUR Score Scale for pediatric intensive care unit (PICU) patients, aiming for enhanced neurological assessment.
To compare the performance of the modified Pediatric FOUR Score Scale (PFSS) against the GCS and Pediatric Cerebral Performance Category (PCPC).

Main Methods:

Experienced PICU nurses were trained as expert raters.
Subjects were assessed using the PFSS, GCS, and Richmond Agitation Sedation Scale at three time points.
Data were compared with PCPC assessments.

Main Results:

The PFSS demonstrated excellent interrater reliability among trained nurse-raters.
The PFSS showed strong correlation with the PCPC for predicting poor outcomes and in-hospital mortality.
No statistically significant differences were found between the PFSS and GCS in this study.

Conclusions:

The PFSS is a reliable tool for assessing neurological status in critically ill pediatric patients, including those who are intubated and/or sedated.
While not statistically superior to the GCS, the PFSS holds potential for providing more comprehensive neurological assessment in specific pediatric populations.