Validation of a new coma scale: The FOUR score
Validation of a new coma scale: The FOUR score
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DOI：
10.1002/ana.20611
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发表时间：
2005-10-01
影响因子：
11.2
通讯作者：
McClelland, RL
中科院分区：
文献类型：
--
作者：
Wijdicks, EFM;Bamlet, WR;McClelland, RL
格拉斯哥昏迷量表（GCS）已被广泛采用。无法评估插管患者的语言评分和无法测试脑干反射是缺点。我们设计了一个新的昏迷评分，四（无反应的完整轮廓）评分。它由四个组成部分（眼睛、运动、脑干和呼吸）组成，每个组成部分的最高评分为4分。我们前瞻性研究了120例重症监护病房患者的FOUR评分，并将其与神经科学护士、神经内科住院医师和神经重症监护医师的GCS评分进行比较。我们发现，评价者间的可靠性是优秀的四分（K-w = 0.82）和良好的医生评价者对优秀。评分者之间的一致性与GCS相似（K-w = 0.82）。GCS评分最低的患者可以使用FOUR评分进一步区分。我们的结论是，评分员之间的协议是好到优秀。FOUR评分提供了比GCS更多的神经学细节，识别闭锁综合征，并且由于脑干反射、呼吸模式的可用性以及识别脑疝不同阶段的能力而上级GCS。与GCS总分最低者相比，FOUR总分最低者的院内死亡概率更高。
The Glasgow Coma Scale (GCS) has been widely adopted. Failure to assess the verbal score in intubated patients and the inability to test brainstem reflexes are shortcomings. We devised a new coma score, the FOUR (Full Outline of UnResponsiveness) score. It consists of four components (eye, motor, brainstem, and respiration), and each component has a maximal score of 4. We prospectively studied the FOUR score in 120 intensive care unit patients and compared it with the GCS score using ncuroscience nurses, neurology residents, and neurointensivists. We found that the interrater reliability was excellent with the FOUR score (K-w = 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (K-w = 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score. We conclude that the agreement among raters was good to excellent. The FOUR score provides greater neurological detail than the GCS, recognizes a locked-in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation. The probability of in-hospital mortality was higher for the lowest total FOUR score when compared with the lowest total GCS score.