Validity of the FOUR Score Coma Scale in the Medical Intensive Care Unit

To evaluate the validity of the FOUR score (ranging from 0-16), a new coma scale that consists of 4 components (eye response, motor response, brainstem reflexes and respiration pattern) when used by ICU members.

or fellow/consultant) . Observer are randomly assigned to pair (nurse/fellow. fellow/fellow. comparison by using FOUR score and GCS score.  100 critically ill patients were observed for interobserver agreement. nurse/consultant.

FOUR score is similar to GCS.   Interobserver agreement with the FOUR score was excellent (similar to GCS). In terms of predictive power for poor neurologic outcome. Mortality rate for patients with the lowest score is higher with the FOUR score (89%) than GCS (71%) .

    Interobserver agreement of FOUR score was excellent. FOUR score is a good predictor of the prognosis of critically ill patients. all components of FOUR score can be evaluated in intubated patients. FOUR score has important advantages over the GCS in ICU setting. In contrast to GCS. .

4 components :  Eye response  Motor response  Brainstem reflexes  Respiratory pattern .

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4 -> moderately severe disability. 5 -> severe disability. symptoms (+) 2 -> slight disability. require constant caring 6 -> death . bed ridden. ADL disturbance (-) 3 -> moderate disability. unable to walk without assistance. incontinent. need some help but able to walk without assistance.Morbidity was assessed at 3 months with Modified Rankin Scale 0 -> no symptoms 1 -> no evident disability.

Pairwise weighted k values Overall weighted k values Intraclass correlation Calculated for FOUR Score and GCS Score Cornbach α calculated for assessment of internal consistency Spearman correlation calculated between FOUR score and GCS score .

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FOUR SCore .

FOUR Score Glasgow Coma Scale .

FOUR Score Glasgow Coma Scale .

    High degree of internal consistency for both FOUR and GCS For every 1 –point increase in the total FOUR Score.hospital mortality were reduced 15%. the odds of in. poor neurologic outcome was reduced 18% (comparable to GCS) 8 of 9 patient with lowest FOUR score died (89%) 15 of 21 patients with lowest GCS score died (71%) .

   The level of interobserver agreement found in the current study was slightly higher than that found by the first validation study An ideal coma scale would be reliable. linear and easy to use The GCS has a number of shortcomings.the verbal component. It could not reliably assesed in 45 of the 100 patients in the study .valid.

   The FOUR score aims to overcome these shortcomings because it is both simple to use and comprehensive. and diagnose a locked-in syndrome . The FOUR score can be easily used in ICU settings The FOUR score accurately predicts poor outcome.detect braindeath.

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