Department of Nursing Research, The MetroHealth System, Cleveland, OH, USA,
Neurocrit Care. 2014 Aug;21(1):52-7. doi: 10.1007/s12028-013-9947-6.
The Glasgow Coma Scale (GCS) is a routine component of a neurological exam for critically ill traumatic brain injury (TBI) patients, yet has been criticized for not accurately depicting verbal status among intubated patients or including brain stem reflexes. Preliminary research on the Full Outline of UnResponsiveness (FOUR) Scale suggests it overcomes these limitations. Research is needed to determine correlations with patient outcomes. The aims of this study were to: (1) examine correlations between 24 and 72 h FOUR and GCS scores and functional/cognitive outcomes; (2) determine relationship between 24 and 72 h FOUR scores and mortality.
Prospective cohort study. Data gathered on adult TBI patients at a Level I trauma center. FOUR scores assigned at 24, 72 h. Functional outcome measured by functional independence measure scores at rehabilitation discharge; cognitive status measured by Weschler Memory Scale scores 3 months post-injury.
n = 136. Mean age 53.1. 72 h FOUR and GCS scores correlated with functional outcome (r s = 0.34, p = 0.05; r s = 0.39, p = 0.02), but not cognitive status. Receiver operating characteristic curves were comparable for FOUR and GCS at 24 and 72 h for functional status (24 h FOUR, GCS = 0.625, 0.602, respectively; 72 h FOUR, GCS = 0.640, 0.688), cognitive status (24 h FOUR, GCS = 0.703, 0.731; 72 h FOUR, GCS = 0.837, 0.674), and mortality (24 h FOUR, GCS = 0.913, 0.935; 72 h FOUR, GCS = 0.837, 0.884).
FOUR is comparable to GCS in terms of predictive ability for functional status, cognitive outcome 3 months post-injury, and in-hospital mortality.
格拉斯哥昏迷量表（GCS）是对重症创伤性脑损伤（TBI）患者进行神经检查的常规组成部分，但它因不能准确描述插管患者的言语状态或不包括脑干反射而受到批评。对全面昏迷反应量表（FOUR）的初步研究表明，它克服了这些局限性。需要研究来确定与患者预后的相关性。本研究的目的是：（1）检查 24 小时和 72 小时 FOUR 和 GCS 评分与功能/认知结果之间的相关性；（2）确定 24 小时和 72 小时 FOUR 评分与死亡率的关系。
前瞻性队列研究。在一级创伤中心收集成年 TBI 患者的数据。24 小时和 72 小时 FOUR 评分。功能结果用康复出院时的功能独立性测量评分衡量；认知状态用韦氏记忆量表评分 3 个月后衡量。
n = 136。平均年龄 53.1。72 小时 FOUR 和 GCS 评分与功能结果相关（r s = 0.34，p = 0.05；r s = 0.39，p = 0.02），但与认知状态无关。24 小时和 72 小时 FOUR 和 GCS 的受试者工作特征曲线在功能状态方面相当（24 小时 FOUR，GCS = 0.625，0.602；72 小时 FOUR，GCS = 0.640，0.688），认知状态（24 小时 FOUR，GCS = 0.703，0.731；72 小时 FOUR，GCS = 0.837，0.674）和死亡率（24 小时 FOUR，GCS = 0.913，0.935；72 小时 FOUR，GCS = 0.837，0.884）。
在预测功能状态、3 个月后的认知结果和住院死亡率方面，FOUR 与 GCS 相当。
