Validation of a new coma scale, the FOUR score, in the emergency department.
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, kappa(w) = 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.


CONCLUSIONS
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.
Stead
Latha G
LG
Department of Emergency Medicine, Mayo Clinic, Generose G 410, Rochester, MN 55905, USA. stead.latha@mayo.edu
Wijdicks
Eelco F M
EF
Bhagra
Anjali
A
Kashyap
Rahul
R
Bellolio
M Fernanda
MF
Nash
David L
DL
Enduri
Sailaja
S
Schears
Raquel
R
William
Bamlet
B
D000328:Adult; D015331:Cohort Studies; D003128:Coma / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D004636:Emergency Service, Hospital; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D020127:Recovery of Function; D015203:Reproducibility of Results; D012119:Respiration; D015599:Trauma Severity Indices; D016896:Treatment Outcome