OBJECTIVE
The FOUR (Full Outline of UnResponsiveness) score is a new coma scale that consists
of 4 components (eye, motor, brainstem, and respiration). The scale was recently validated,
but variability among nursing staff has been documented.
PATIENTS AND METHODS
We prospectively studied the FOUR score in 80 patients with acute neurologic disease
in an intensive care unit (ICU) and compared it with the Glasgow Coma Scale (GCS)
using 20 experienced and inexperienced neuroscience ICU nurses and nonneuroscience
ICU nurses. Each nurse was trained with the use of video examples and instruction
cards. Each patient was rated by 2 nurses, with the order randomly assigned.
RESULTS
The rater agreement was good to excellent with the FOUR score (weighted κ: eye, 0.84;
respiration, 0.92; brainstem, 0.89; and motor, 0.73) and similar to that for the GCS
(weightedκ: eye, 0.85; verbal, 0.89; and motor, 0.74). Greater average experience
in years was associated with less disagreement, but the difference was not statistically
significant.
CONCLUSION
The FOUR score provides more neurologic information than the GCS. The FOUR score can
be used by any ICU nurses, even those with minimal experience.
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REFERENCES
- Validation of a new coma scale: the FOUR score.Ann Neurol. 2005; 58: 585-593
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Statistics notes: Cronbach's alpha.BMJ. 1997; 314: 572
- Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users.Lancet. 1991; 337: 535-538
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Copyright
© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
