Related Experiment Videos
[Translation and Validation of the FOUR Scale for Children and its Use as Outcome Predictor: A Pilot Study]
Sofia Simões Ferreira1, Daniel Meireles2, Alexandra Pinto3
1Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal.
Insights
The Portuguese Full Outline of UnResponsiveness (FOUR) scale is reliable for assessing pediatric patients with impaired consciousness in intensive care. It offers better neurological insights and prognostic value compared to the Glasgow Coma Scale.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Clinical Assessment Tools
Background:
- The Full Outline of UnResponsiveness (FOUR) scale is validated for adult impaired consciousness assessment.
- Its translation and validation in the pediatric population are necessary.
- Comparison with the Glasgow Coma Scale (GCS) in pediatric intensive care is needed.
Purpose of the Study:
- Translate and validate the FOUR scale for Portuguese-speaking pediatric patients.
- Compare the FOUR scale with the GCS in assessing pediatric patients with impaired consciousness.
- Evaluate the prognostic value of both scales in Pediatric Intensive Care Units (PICUs).
Main Methods:
- Prospective study of pediatric patients (1-17 years) with impaired consciousness in PICUs over one year.
- Daily application of both FOUR and GCS scales by intensivists, residents, and nurses.
- Neurological sequelae assessed using the King's Outcome Scale for Childhood Head Injury (KOSCHI).
Main Results:
- Twenty-seven pediatric patients were included.
- Both scales demonstrated reliability, with higher inter-rater reliability for the FOUR scale.
- The FOUR scale showed a stronger association with patient outcomes (AUC=0.939) than the GCS (AUC=0.925).
Conclusions:
- The Portuguese FOUR scale is a reliable tool for assessing impaired consciousness in pediatric patients in PICUs.
- The FOUR scale provides more comprehensive neurological information and has greater prognostic value than the GCS.
- Further multicenter studies are recommended to generalize findings.
Introduction:
The Full Outline of UnResponsiveness - FOUR scale has been previously validated to assess impaired consciousness in the adult population. The aim of this study is the translation into Portuguese and validation of the FOUR scale in the pediatric population. The study also compares the FOUR scale and Glasgow coma scale score ratings and the clinical outcome of patients hospitalized in Pediatric Intensive Care Units.
Material And Methods:
This study prospectively rated patients admitted to the Pediatric Intensive Care Units with impaired consciousness during one year. Both scales were applied daily to patients by three types of examiners: intensivists, residents and nurses, from the moment of admission until clinical discharge. Neurological sequelae was evaluated using the King's Outcome Scale for Childhood Head Injury - KOSCHI.
Results:
Twenty seven patients between one and 17 years of age were included. Both scales are reliable and inter-rater reliability was greater for the FOUR score. Glasgow coma scale showed a minimum score in eight evaluations, whereas the FOUR scale obtained the minimum score in only two of these evaluations. In both scales there was a strong association between the admission score and the patient's outcome (area under curve FOUR = 0.939, versus Glasgow coma scale = 0.925).
Discussion:
The FOUR scale provides more neurological information than Glasgow coma scale in patients with impaired consciousness and has prognostic interest.
Conclusion:
The FOUR scale can be applied in patients admitted with impaired consciousness in Pediatric Intensive Care Units. We think that a multicenter study would be very beneficial for confirming and generalizing these results.