跨文化调适与希腊版“全面无反应评分量表”的验证：神经外科患者的前瞻性观察临床计量学研究。
Cross-Cultural Adaptation and Validation of the Greek Version of the "Full Outline of Unresponsiveness Score": A Prospective Observational Clinimetric Study in Neurosurgical Patients.
机构信息
Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, 49 Konstantinoupoleos Str., 54642, Thessaloniki, Greece.
Department of Neurosurgery, AHEPA University Hospital, Aristotle University School of Medicine, Thessaloniki, Greece.
出版信息
Neurocrit Care. 2022 Apr;36(2):584-594. doi: 10.1007/s12028-021-01342-w. Epub 2021 Sep 23.
BACKGROUND
The Full Outline of Unresponsiveness (FOUR) score is a clinical instrument for the assessment of consciousness which is gradually gaining ground in clinical practice, as it incorporates more complete neurological information than the Glasgow Coma Scale (GCS). The main objectives of the current study were the following: (1) translate and cross-culturally adapt the FOUR score into Greek; (2) evaluate its clinimetric properties, including interrater reliability, internal consistency, and construct validity; and (3) evaluate the reliability of assessments among health care professionals with different levels of experience and training.
METHODS
The FOUR score was initially translated into Greek. Next, patients with neurosurgical pathologies in need of consciousness monitoring were independently assessed with the GCS and FOUR score within one hour by four raters who had different levels of experience and training (two board-certified neurosurgeons, a neurosurgery resident, and a registered nurse). Interrater reliability, internal consistency, and construct validity were evaluated for the scales using weighted Cohen's κ (κ) and intraclass correlation coefficients (ICC), Cronbach's α and Spearman's ρ values, respectively.
RESULTS
A total of 408 assessments were performed for 99 patients. The interrater reliability was excellent for both the FOUR score (ICC = 0.941) and GCS (ICC = 0.936). The values of κ exceeded 0.90 for all pairs, suggesting that the FOUR score can be reliably applied by raters with varying experience. Among the scales' components, FOUR score's brainstem and respiratory items showed the lowest, yet high enough (κ > 0.60), level of agreement. The interrater reliability remained excellent (κ > 0.85, ICC > 0.90) for all diagnosis and age groups, with a trend toward higher FOUR score values in the most severe cases (ICC = 0.813 vs. 0.723). Both the FOUR score and GCS showed high internal consistency (Cronbach's α > 0.70 for all occasions). The FOUR score correlated strongly with GCS (Spearman's ρ > 0.90 for all raters), suggesting high construct validity.
CONCLUSIONS
The Greek version of the FOUR score is a valid and reliable tool for the clinical assessment of patients with disorders of consciousness. It can be applied successfully by nurses, residents, and specialized physicians. Therefore, its use by medical practitioners with different levels of experience and training is strongly encouraged.
背景
全面无反应性评估量表（FOUR）是一种评估意识的临床工具，它比格拉斯哥昏迷量表（GCS）纳入了更完整的神经学信息，因此在临床实践中逐渐得到应用。本研究的主要目的如下：（1）将 FOUR 量表翻译成希腊语；（2）评估其临床计量学特性，包括评分者间信度、内部一致性和结构效度；（3）评估不同经验和培训水平的医护人员评估的可靠性。
方法
首先，我们将 FOUR 量表翻译成希腊语。然后，由 4 名评分者在 1 小时内独立评估患有神经外科疾病且需要监测意识的患者，评分者的经验和培训水平不同（2 名神经外科认证医师、1 名神经外科住院医师和 1 名注册护士）。我们使用加权 Cohen's κ（κ）和组内相关系数（ICC）、克朗巴赫的 α 和斯皮尔曼的 ρ 值分别评估量表的评分者间信度、内部一致性和结构效度。
结果
共对 99 例患者的 408 次评估进行了分析。对于 FOUR 量表（ICC=0.941）和 GCS（ICC=0.936），评分者间信度均为优。所有配对的κ值均大于 0.90，表明 FOUR 量表可由经验不同的评分者可靠地应用。在量表的各个组成部分中，FOUR 量表的脑干和呼吸项目的一致性最低，但一致性仍较高（κ>0.60）。在所有诊断和年龄组中，评分者间信度仍为优（κ>0.85，ICC>0.90），且最严重病例的 FOUR 量表值呈升高趋势（ICC=0.813 比 0.723）。FOUR 量表和 GCS 的内部一致性均较高（所有情况下克朗巴赫的 α>0.70）。FOUR 量表与 GCS 相关性较强（所有评分者的斯皮尔曼的 ρ>0.90），表明具有较高的结构效度。
结论
希腊语版 FOUR 量表是评估意识障碍患者的一种有效且可靠的工具。它可以由护士、住院医师和专科医师成功应用。因此，我们强烈鼓励不同经验和培训水平的医疗从业者使用该量表。
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