title: Predictive Validity and Inter-Rater Reliability of the Persian Version of Full Outline of Unresponsiveness Among Unconscious Patients with Traumatic Brain Injury in an Intensive Care Unit.
abstract: BACKGROUND
  The Glasgow Coma Scale (GCS) has some limitations when evaluating the unconscious patient. This study aims to validate the Persian version of the FOUR (Full Outline of Unresponsiveness) score as a proposed substitute.
  
  
  METHODS
  Two nurses, two nursing students, and two physicians scored the prepared Persian version of the FOUR and GCS in 84 patients with acute brain injury. The inter-rater agreement for the FOUR and the GCS scores was evaluated by the weighted kappa (κw). The outcome prediction power of the scales was assessed by the area under the curve (AUC) in the ROC curve.
  
  
  RESULTS
  The inter-rater agreement of the FOUR was excellent (κw= 0.923, 95 % CI, 0.874-0.971) and comparable with the one of the GCS (κw= 0.938, 95 % CI, 0.889-0.987). The area under the curve (AUC) for predicting in-hospital mortality (modified Rankin Scale: 6) was 0.835 for the FOUR (95 % CI, 0.739-0.907) and 0.772 for the GCS (95 % CI, 0.668-0.856) (P = 0.01). AUC for predicting poor outcome (modified Rankin Scale: 3-6) for the total FOUR score was 0.983 (95 % CI, 0.928-0.999), which is comparable with 0.987 for the total GCS score (95 % CI, 0.934-1.000).
  
  
  CONCLUSIONS
  The researchers conclude that the Persian version of the FOUR score is a reliable and valid scale to assess unconscious patients with traumatic brain injury and can be substituted for the GCS.
authors.affiliation: Epidemiology and Biostatistics Department, Qom University of Medical Sciences, Qom, Iran. somy.momenyan@gmail.com.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Momenyan
authors.affiliation: Qom University of Medical Sciences, Qom, Iran.
authors.forename: Sey Mojtaba
authors.initials: SM
authors.lastname: Mousavi
authors.affiliation: Academic Member of Midwifery, Midwifery Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Tahmineh
authors.initials: T
authors.lastname: Dadkhahtehrani
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Science, Hamadan, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Sarvi
authors.affiliation: Medicine, Quran and Hadith Research Center, Bagiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Heidarifar
authors.affiliation: Qom Branch Azad University, Qom, Iran.
authors.forename: Faezeh
authors.initials: F
authors.lastname: Kabiri
authors.affiliation: Qom University of Medical Sciences, Qom, Iran.
authors.forename: Erfan
authors.initials: E
authors.lastname: Mohebi
authors.affiliation: Qom University of Medical Sciences, Qom, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Koohbor
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis*; D020207:Coma, Post-Head Injury / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015599:Trauma Severity Indices
keywords: Acute brain injury; Coma scale; Full Outline of Unresponsiveness score; Glasgow Coma Scale; Iran; Outcome predictor; Persian