Abstract
Objective
Full Outline of Unresponsiveness (FOUR) score has previously been validated scale in the Neurosciences Intensive Care Unit. In this study, we sought to validate the use of FOUR score in the emergency department (ED) using non-neurology staff. We also compared its performance to the Glasgow Coma Scale (GCS) and correlated it to functional outcome at hospital discharge and overall survival.
Methods
We prospectively rated 69 patients with initial neurologic symptoms presenting to the ED. Three types of examiners performed the FOUR score: ED physician, ED resident, and ED nurse. Patients were followed through hospital discharge; functional outcome was measured using modified Rankin Score (mRS).
Results
Interrater reliability for FOUR score and GCS was excellent (respectively, κw = 0.88 and 0.86). Both FOUR score and GCS predicted functional outcome, and overall survival with and without adjustment for age, sex, and alertness group.
Conclusion
The FOUR score can be reliably used in the ED by non-neurology staff. Both FOUR score and GCS performed equally well, but the neurologic detail incorporated in the FOUR score makes it more useful in management and triage of patients.
Similar content being viewed by others
References
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4. doi:10.1016/S0140-6736(74)91639-0.
Kerby JD, MacLennan PA, Burton JN, McGwin G Jr, Rue LWIII. Agreement between prehospital and emergency department Glasgow coma scores. J Trauma. 2007;63:1026–31.
Menegazzi JJ, Davis EA, Sucov AN, Paris PM. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma. 1993;34:46–8. doi:10.1097/00005373-199301000-00008.
Báez AA, Giráldez EM, De Peña JM. Precision and reliability of the Glasgow Coma Scale score among a cohort of Latin American prehospital emergency care providers. Prehosp Disaster Med. 2007;22:230–2.
Gill MR, Reiley DG, Green SM. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. 2004;43:215–23. doi:10.1016/S0196-0644(03)00814-X.
Holdgate A, Ching N, Angonese L. Variability in agreement between physicians and nurses when measuring the Glasgow Coma Scale in the emergency department limits its clinical usefulness. Emerg Med Australas. 2006;18:379–84. doi:10.1111/j.1742-6723.2006.00867.x.
Buechler CM, Blostein PA, Koestner A, Hurt K, Schaars M, McKernan J. Variation among trauma centers’ calculation of Glasgow Coma Scale score: results of a national survey. J Trauma. 1998;45:429–32. doi:10.1097/00005373-199809000-00001.
Wijdicks EF. Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR score. Rev Neurol Dis. 2006;3:109–17.
Wijdicks EF, Bamlet WR, Maramattom BV, et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58:585–93. doi:10.1002/ana.20611.
Wolf CA, Wijdicks EF, Bamlet WR, et al. Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clin Proc. 2007;82:435–8.
Sternbach GL. The Glasgow Coma Scale. J Emerg Med. 2000;19:67–71. doi:10.1016/S0736-4679(00)00182-7.
Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2(5):200–15.
van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biostatistics. 1977;33:159–74.
Haukoos JS, Gill MR, Rabon RE, Gravitz CS, Green SM. Validation of the simplified motor score for the prediction of brain injury outcomes after trauma. Ann Emerg Med. 2007;50:18–24. doi:10.1016/j.annemergmed.2006.10.004.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stead, L.G., Wijdicks, E.F.M., Bhagra, A. et al. Validation of a New Coma Scale, the FOUR Score, in the Emergency Department. Neurocrit Care 10, 50–54 (2009). https://doi.org/10.1007/s12028-008-9145-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-008-9145-0