Wijdicks Eelco F M, Bamlet William R, Maramattom Boby V, Manno Edward M, McClelland Robyn L
Division of Critical Care Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Ann Neurol. 2005 Oct;58(4):585-93. doi: 10.1002/ana.20611.
The Glasgow Coma Scale (GCS) has been widely adopted. Failure to assess the verbal score in intubated patients and the inability to test brainstem reflexes are shortcomings. We devised a new coma score, the FOUR (Full Outline of UnResponsiveness) score. It consists of four components (eye, motor, brainstem, and respiration), and each component has a maximal score of 4. We prospectively studied the FOUR score in 120 intensive care unit patients and compared it with the GCS score using neuroscience nurses, neurology residents, and neurointensivists. We found that the interrater reliability was excellent with the FOUR score (kappa(w) = 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (kappa(w) = 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score. We conclude that the agreement among raters was good to excellent. The FOUR score provides greater neurological detail than the GCS, recognizes a locked-in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation. The probability of in-hospital mortality was higher for the lowest total FOUR score when compared with the lowest total GCS score.
格拉斯哥昏迷量表（GCS）已被广泛采用。对插管患者未评估言语评分以及无法测试脑干反射是其不足之处。我们设计了一种新的昏迷评分，即FOUR（全面无反应大纲）评分。它由四个部分（眼睛、运动、脑干和呼吸）组成，每个部分的最高分均为4分。我们对120名重症监护病房患者的FOUR评分进行了前瞻性研究，并由神经科学护士、神经内科住院医师和神经重症医师将其与GCS评分进行比较。我们发现，FOUR评分的评分者间信度极佳（kappa(w)=0.82），医师评分者对的信度良好至极佳。评分者之间的一致性与GCS相似（kappa(w)=0.82）。使用FOUR评分可以进一步区分GCS评分最低的患者。我们得出结论，评分者之间的一致性良好至极佳。FOUR评分比GCS提供了更多的神经学细节，识别闭锁综合征，并且由于脑干反射、呼吸模式的可用性以及识别不同疝出阶段的能力而优于GCS。与最低总GCS评分相比，最低总FOUR评分的患者院内死亡概率更高。
