Epidemiology and Biostatistics Department, Qom University of Medical Sciences, Qom, Iran.
Qom University of Medical Sciences, Qom, Iran.
Neurocrit Care. 2017 Oct;27(2):229-236. doi: 10.1007/s12028-016-0324-0.
The Glasgow Coma Scale (GCS) has some limitations when evaluating the unconscious patient. This study aims to validate the Persian version of the FOUR (Full Outline of Unresponsiveness) score as a proposed substitute.
Two nurses, two nursing students, and two physicians scored the prepared Persian version of the FOUR and GCS in 84 patients with acute brain injury. The inter-rater agreement for the FOUR and the GCS scores was evaluated by the weighted kappa (κ ). The outcome prediction power of the scales was assessed by the area under the curve (AUC) in the ROC curve.
The inter-rater agreement of the FOUR was excellent (κ = 0.923, 95 % CI, 0.874-0.971) and comparable with the one of the GCS (κ = 0.938, 95 % CI, 0.889-0.987). The area under the curve (AUC) for predicting in-hospital mortality (modified Rankin Scale: 6) was 0.835 for the FOUR (95 % CI, 0.739-0.907) and 0.772 for the GCS (95 % CI, 0.668-0.856) (P = 0.01). AUC for predicting poor outcome (modified Rankin Scale: 3-6) for the total FOUR score was 0.983 (95 % CI, 0.928-0.999), which is comparable with 0.987 for the total GCS score (95 % CI, 0.934-1.000).
The researchers conclude that the Persian version of the FOUR score is a reliable and valid scale to assess unconscious patients with traumatic brain injury and can be substituted for the GCS.
格拉斯哥昏迷量表（GCS）在评估无意识患者时存在一些局限性。本研究旨在验证 FOUR（全面无反应评分）的波斯版本作为替代方案的有效性。
两名护士、两名护理学生和两名医生对 84 名急性脑损伤患者的准备好的 FOUR 和 GCS 进行了评分。通过加权 Kappa（κ）评估 FOUR 和 GCS 评分的观察者间一致性。通过 ROC 曲线下面积（AUC）评估量表的预测结果。
FOUR 的观察者间一致性极好（κ=0.923，95%CI，0.874-0.971），与 GCS 的一致性相当（κ=0.938，95%CI，0.889-0.987）。预测住院死亡率（改良 Rankin 量表：6）的曲线下面积（AUC）为 FOUR 为 0.835（95%CI，0.739-0.907），GCS 为 0.772（95%CI，0.668-0.856）（P=0.01）。总 FOUR 评分预测不良结局（改良 Rankin 量表：3-6）的 AUC 为 0.983（95%CI，0.928-0.999），与总 GCS 评分的 0.987（95%CI，0.934-1.000）相当。
研究人员得出结论，FOUR 评分的波斯版本是评估创伤性脑损伤无意识患者的可靠和有效的量表，可以替代 GCS。
