St. John's Mercy Medical Center, St Louis University, St. Louis, MO 63141, USA.
Neurocrit Care. 2012 Feb;16(1):95-101. doi: 10.1007/s12028-011-9617-5.
The most widely used and most studied coma score to date is the Glasgow Coma Scale (GCS), which is used worldwide to assess level of consciousness and predict outcome after traumatic brain injury (TBI). Our aim was to determine whether the Full Outline of UnResponsiveness (FOUR) score is an accurate predictor of outcome in TBI patients and to compare its performance to GCS.
We prospectively identified TBI patients admitted to our Neuro-ICU between July 2010 and February 2011. We enrolled 51 patients. The FOUR score and GCS were determined by one of the investigators. Outcomes were in-hospital mortality, and poor neurologic outcome (Glasgow Outcome Scale (GOS) 1-3 and Modified Rankin Scale (mRS) score 3-6) at 3-6 months.
There was a high degree of internal consistency for both the FOUR score (Cronbach's alpha = 0.89) and GCS (Cronbach's alpha = 0.85). In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic (ROC) curve was 0.93 for FOUR score and 0.89 for GCS. In terms of predictive power of poor neurologic outcome at 3-6 months, the area under the ROC curve was 0.85 for FOUR score and 0.83 for GCS as evidenced by GOS 1-3, and 0.80 for FOUR score and 0.78 for GCS as evidenced by mRS 3-6. The odds ratio (OR) for in-hospital mortality was 0.64 (0.46-0.88) from FOUR score and 0.63 (0.45-0.89) from GCS, for poor neurologic outcome was 0.67 (0.53-0.85) from FOUR score and 0.65 (0.51-0.83) from GCS for GOS, and was 0.71 (0.57-0.87) from FOUR score and 0.71 (0.57-0.87) from GCS for mRS.
The FOUR score is an accurate predictor of outcome in TBI patients. It has some advantages over GCS, such as all components of FOUR score but not GCS can be rated in intubated patients.
迄今为止，使用最广泛、研究最多的昏迷评分是格拉斯哥昏迷评分（GCS），该评分被全世界用于评估意识水平和预测创伤性脑损伤（TBI）后的结果。我们的目的是确定全面昏迷反应评估量表（FOUR）评分是否是 TBI 患者预后的准确预测指标，并将其与 GCS 进行比较。
我们前瞻性地确定了 2010 年 7 月至 2011 年 2 月期间入住我们神经重症监护病房的 TBI 患者。我们纳入了 51 名患者。FOUR 评分和 GCS 由一名研究人员确定。结局是院内死亡率和 3-6 个月时的不良神经结局（格拉斯哥结局量表（GOS）1-3 分和改良 Rankin 量表（mRS）评分 3-6 分）。
FOUR 评分（克朗巴赫α=0.89）和 GCS（克朗巴赫α=0.85）的内部一致性都很高。就院内死亡率的预测能力而言，FOUR 评分的受试者工作特征（ROC）曲线下面积为 0.93，GCS 的曲线下面积为 0.89。就 3-6 个月时不良神经结局的预测能力而言，FOUR 评分的 ROC 曲线下面积为 0.85（GOS 1-3 分），GCS 的曲线下面积为 0.83（GOS 1-3 分），FOUR 评分的曲线下面积为 0.80（mRS 3-6 分），GCS 的曲线下面积为 0.78（mRS 3-6 分）。FOUR 评分的比值比（OR）为 0.64（0.46-0.88），GCS 的 OR 为 0.63（0.45-0.89），FOUR 评分的 OR 为 0.67（0.53-0.85），GCS 的 OR 为 0.65（0.51-0.83）。GOS 的 OR 为 0.71（0.57-0.87），GCS 的 OR 为 0.71（0.57-0.87）。mRS 的 OR 为 0.71（0.57-0.87），GCS 的 OR 为 0.71（0.57-0.87）。
FOUR 评分是 TBI 患者预后的准确预测指标。它比 GCS 有一些优势，例如 FOUR 评分的所有组成部分，但 GCS 不能在插管患者中进行评分。
