title: Validation of the Chinese version of the FOUR score in the assessment of neurosurgical patients with different level of consciousness.
abstract: BACKGROUND
  The Glasgow Coma Scale (GCS) is currently the most widely used scoring system for comatose patients. A decade ago, the Full Outline of Unresponsiveness (FOUR) score was devised to better capture four functional aspects of consciousness (eye, motor responses, brainstem reflexes, and respiration). This study aimed to validate the Chinese version of the FOUR score in patients with different levels of consciousness.
  
  
  METHODS
  The study had two phases: (1) translation of the FOUR score, and (2) assessment of its reliability and validity. The Chinese version of the FOUR score was developed according to a standardized protocol. One hundred-twenty consecutive patients with acute brain damage, admitted to Nanfang Hospital (Southern Medical University, Guangdong, China) from November 2014 to February 2015, were enrolled. The inter-rater agreement for the FOUR score and GCS was evaluated using intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were established to determine the scales' abilities to predict outcome.
  
  
  RESULTS
  The rater agreement was excellent both for FOUR (ICC = 0.970; p < 0.001) and GCS (ICC = 0.958; p < 0.001). The FOUR score yielded an excellent test-retest reliability (ICC = 0.930; p < 0.001). Spearman's correlation coefficients between GCS and the FOUR score were high: r = 0.932, first rating; r = 0.887, second rating (all p < 0.001). Areas under the curve (AUC) for mortality were 0.834 (95 % CI, 0.740-0.928) and 0.815 (95 % CI, 0.723-0.908) for the FOUR score and GCS, respectively.
  
  
  CONCLUSIONS
  The Chinese version of the FOUR score is a reliable scale for evaluating the level of consciousness in patients with acute brain injury.
authors.affiliation: Department of Nursing, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. pengjuan2014@hotmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Peng
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. 13560359661@139.com.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, 510515, China. cfy811@126.com.
authors.forename: Fangyao
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. 15626451842@163.com.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. 1095945320@qq.com.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Wang
authors.affiliation: Intensive Care Unit, Cancer Center of Guangzhou Medical University, Guangdong, 510095, China. 54480217@qq.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Nursing, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. zhouhz2005@hotmail.com.
authors.forename: Hongzhen
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangdong, 510515, China. qiubh150@sina.com.
authors.forename: Binghui
authors.initials: B
authors.lastname: Qiu
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D002681:China; D003244:Consciousness Disorders / Q000145:classification* / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D014175:Translating; D015599:Trauma Severity Indices