title: Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an intensive care unit population.
abstract: BACKGROUND
  The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liège Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state.
  
  
  METHODS
  FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) brain-damaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Inter-rater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136).
  
  
  RESULTS
  GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit.
  
  
  CONCLUSIONS
  The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales.
authors.affiliation: Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Sart-Tilman (B30), 4000 Liège, Belgium.
authors.forename: Marie-Aurélie
authors.initials: MA
authors.lastname: Bruno
authors.forename: Didier
authors.initials: D
authors.lastname: Ledoux
authors.forename: Bernard
authors.initials: B
authors.lastname: Lambermont
authors.forename: François
authors.initials: F
authors.lastname: Damas
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Olivia
authors.initials: O
authors.lastname: Gosseries
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D001925:Brain Damage, Chronic / Q000145:classification / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D015588:Observer Variation; D018458:Persistent Vegetative State / Q000175:diagnosis*; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data