- Poster presentation
- Published:
Full Outline of Unresponsiveness compared with Glasgow coma scale assessment and outcome prediction in coma
Critical Care volume 13, Article number: P107 (2009)
Introduction
The most widely adopted scale to assess consciousness in severely brain-damaged patients is the Glasgow coma scale (GCS) [1]. Its major shortcomings are the failure to assess the verbal component in intubated patients, the inability to test brainstem reflexes and breathing patterns. In 2005, Wijdicks and colleagues proposed a new coma scale, the Full Outline of Unresponsiveness (FOUR) scale [2], which consists of four components (eye, motor, brainstem, and respiration), each component having a maximal score of 4. Our objective was to validate the French version of the new FOUR coma scale in a general ICU and to assess its predictive value as compared with the GCS.
Methods
We performed FOUR and GCS evaluations in randomized order in 176 acutely brain-injured patients (days from insult to randomization <1 month). We assessed the association between GCS and FOUR scores using the Spearman correlation coefficient. A logistic regression analysis adjusted for age and etiology of coma was performed to assess the link between the studied scores and the outcome based on the Glasgow outcome scales 3 months after injury (n = 63).
Results
The GCS and FOUR showed a significant correlation (r = 0.807). The GCS verbal component was scored 1 in 146 patients; among these, 131 were intubated. The FOUR total scores (corrected for age) showed superior outcome prediction at 3 months (OR = 0.83; 95% CI = 0.70 to 0.98, P = 0.03) as compared with GCS total scores (OR = 0.85; 95% CI = 0.70 to 1.03, P = 0.09).
Conclusion
The FOUR scale does not need a verbal response, thus allowing complete testing in intubated patients (in our sample 90% of patients showing a GCS V1 score were intubated). Most importantly, the FOUR scale demonstrated a better discrimination between the good (recovery of independent living) and poor neurological status at 3 months as compared with the GCS.
References
Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974, 2: 81-84. 10.1016/S0140-6736(74)91639-0
Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL: Validation of a new coma scale: the FOUR score. Ann Neurol 2005, 58: 585-593. 10.1002/ana.20611
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ledoux, D., Bruno, M., Jonlet, S. et al. Full Outline of Unresponsiveness compared with Glasgow coma scale assessment and outcome prediction in coma. Crit Care 13 (Suppl 1), P107 (2009). https://doi.org/10.1186/cc7271
Published:
DOI: https://doi.org/10.1186/cc7271