A multicenter prospective study of interobserver agreement using the Full Outline of Unresponsiveness score coma scale in the intensive care unit.
OBJECTIVE
The classification of the comatose patient has been greatly improved with the use of coma scales. The Full Outline of Unresponsiveness score has emerged as an alternative to the Glasgow Coma Scale in that it incorporates essential information needed to assess the depth of coma. One set of patients for which the Full Outline of Unresponsiveness score could be particularly beneficial is those admitted to an intensive care unit, where approximately 30%-35% of all patients are intubated or ventilated. This manuscript reports on a study that examined the inter-rater reliability of the Full Outline of Unresponsiveness score in five intensive care units.


METHODS
Seven intensive care units at five U.S. hospitals partici-pated.


METHODS
Patients admitted during parts of 2010 and 2011 had their Full Outline of Unresponsiveness score assessed independently by two nurses within 1 hr of admission.


METHODS
We evaluated the weighted kappa statistic of the Full Outline of Unresponsiveness score over all patients and stratified by mechanical ventilation status. Finally, we looked for evidence of heterogeneity in Full Outline of Unresponsiveness score agreement across hospitals.


RESULTS
A total of 907 adult critically ill patients had Full Outline of Unresponsiveness score assessments by two evaluators. The overall weighted kappa statistic was 0.92, and this did not differ by whether or not a patient was on a ventilator. Among hospitals there was modest heterogeneity for the weighted kappa; however, all of the values were >0.80.


CONCLUSIONS
The Full Outline of Unresponsiveness score showed excellent inter-rater agreement overall and at each of the five hospitals. This demonstrates that the Full Outline of Unresponsiveness score can be utilized reliably in critically ill patients.
Cerner Corporation, Vienna, VA, USA.
Andrew A
AA
Kramer
Eelco F M
EF
Wijdicks
Vicki L
VL
Snavely
Jessica R
JR
Dunivan
Linda L Smitz
LL
Naranjo
Shonna
S
Bible
Thomas
T
Rohs
Stacy M
SM
Dickess
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003128:Coma / Q000145:classification* / Q000175:diagnosis; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D014474:Unconsciousness / Q000145:classification / Q000175:diagnosis; D014481:United States