Cerner Corporation, Vienna, VA, USA.
Crit Care Med. 2012 Sep;40(9):2671-6. doi: 10.1097/CCM.0b013e318258fd88.
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.
Seven intensive care units at five U.S. hospitals partici-pated.
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.
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.
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.
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.
昏迷患者的分类在使用昏迷评分后得到了极大的改善。全面昏迷反应评估量表已经成为格拉斯哥昏迷评分的替代方法，因为它纳入了评估昏迷深度所需的基本信息。全面昏迷反应评估量表特别适用于一组患者，即入住重症监护病房的患者，其中约 30%-35%的患者需要插管或通气。本文报告了一项研究，该研究在五个重症监护病房中检查了全面昏迷反应评估量表的组内一致性。
五家美国医院的七个重症监护病房参与了这项研究。
在 2010 年和 2011 年的部分时间内入院的患者，在入院后 1 小时内由两名护士独立评估全面昏迷反应评估量表。
我们评估了所有患者的全面昏迷反应评估量表的加权 kappa 统计量，并按机械通气状态进行分层。最后，我们寻找了全面昏迷反应评估量表在医院间一致性的异质性证据。
共有 907 名成年危重症患者由两名评估者进行了全面昏迷反应评估量表评估。总体加权 kappa 统计量为 0.92，且与患者是否使用呼吸机无关。在医院之间，加权 kappa 存在适度的异质性；然而，所有的数值都>0.80。
全面昏迷反应评估量表总体上和在五个医院中的每个医院都表现出极好的组内一致性。这表明全面昏迷反应评估量表可以在危重症患者中可靠地使用。
