Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
J Crit Care. 2013 Jun;28(3):316.e1-8. doi: 10.1016/j.jcrc.2012.06.009. Epub 2012 Aug 9.
Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score.
Adult patients with altered mental status due to medical causes were rated by neurology consultants and internal medicine residents on FS and GCS. Interobserver reliability for GCS and FS was assessed using κ score. Relation with outcomes was explored using univariate and multivariate analyses.
Of the 100 patients (age, 62 ± 17 years), 60 had neurologic conditions; 26, metabolic encephalopathy; 9, infections; and 7, others. Thirty-nine patients died at 3 months. κ Scores ranged from 0.71 to 0.85 for GCS and from 0.71 to 0.95 for FS. On multivariate analysis, GCS was predictive of outcome at 3 months; FS was predictive of mortality. Area under the receiver operating characteristic curves suggested equivalent performance of both scoring systems.
Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
全面意识障碍评分（FS）是一种最近描述的用于评估意识改变的评分系统。本研究检查了 FS 和格拉斯哥昏迷评分（GCS）在有精神状态改变的内科患者中的评分者间可靠性，并比较了 GCS、FS 和序贯性器官衰竭评估评分对预后的预测能力。
因医学原因导致意识改变的成年患者由神经病学顾问和内科住院医师进行 FS 和 GCS 评分。使用κ评分评估 GCS 和 FS 的观察者间可靠性。使用单变量和多变量分析探讨与结果的关系。
100 例患者（年龄 62 ± 17 岁）中，60 例为神经科疾病；26 例为代谢性脑病；9 例为感染；7 例为其他疾病。39 例患者在 3 个月时死亡。GCS 的κ评分范围为 0.71 至 0.85，FS 的κ评分范围为 0.71 至 0.95。多变量分析显示，GCS 是 3 个月时预后的预测因素；FS 是死亡率的预测因素。受试者工作特征曲线下面积表明这两种评分系统的性能相当。
FS 的评分者间可靠性和预后预测能力与 GCS 相当。本研究支持在医疗病房中使用 FS 评估意识改变。
