title: Validation of a new coma scale, the FOUR score, in the emergency department.
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, 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.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Generose G 410, Rochester, MN 55905, USA. stead.latha@mayo.edu
authors.forename: Latha G
authors.initials: LG
authors.lastname: Stead
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: Anjali
authors.initials: A
authors.lastname: Bhagra
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
authors.forename: David L
authors.initials: DL
authors.lastname: Nash
authors.forename: Sailaja
authors.initials: S
authors.lastname: Enduri
authors.forename: Raquel
authors.initials: R
authors.lastname: Schears
authors.forename: Bamlet
authors.initials: B
authors.lastname: William
mesh_terms: 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