The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.
Validation of a new coma scale: The FOUR score
Abstract
The Glasgow Coma Scale (GCS) has been widely adopted. Failure to assess the verbal score in intubated patients and the inability to test brainstem reflexes are shortcomings. We devised a new coma score, the FOUR (Full Outline of UnResponsiveness) score. It consists of four components (eye, motor, brainstem, and respiration), and each component has a maximal score of 4. We prospectively studied the FOUR score in 120 intensive care unit patients and compared it with the GCS score using neuroscience nurses, neurology residents, and neurointensivists. We found that the interrater reliability was excellent with the FOUR score (κ w = 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (κ w = 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score. We conclude that the agreement among raters was good to excellent. The FOUR score provides greater neurological detail than the GCS, recognizes a locked‐in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation. The probability of in‐hospital mortality was higher for the lowest total FOUR score when compared with the lowest total GCS score. Ann Neurol 2005;58:585–593
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Citations
Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS
Teasdale, G., & Jennett, B. (1974) · The Lancet · doi:10.1016/s0140-6736(74)91639-0 · Cited by 13,215
Interobserver agreement for the assessment of handicap in stroke patients
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Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years.
Balestreri, M., Czosnyka, M., Chatfield, D. A., Steiner, L. A., Schmidt, E. A., Smielewski, P. S., MATTA, B. F., & Pickard, J. D. (2004) · PubMed · Cited by 307
Observer variability in assessing impaired consciousness and coma.
Teasdale, G., Knill-Jones, R., & van der Sande, J. (1978) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.41.7.603 · Cited by 294
Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users
Rowley, G., & Fielding, K. (1991) · The Lancet · doi:10.1016/0140-6736(91)91309-i · Cited by 266
A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85)
Starmark, J.-E., Stålhammar, D., Holmgren, E., & Rosander, B. (1988) · Journal of Neurosurgery · doi:10.3171/jns.1988.69.5.0699 · Cited by 202
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RELIABILITY OF THE GLASGOW COMA SCALE WHEN USED BY EMERGENCY PHYSICIANS AND PARAMEDICS
Menegazzi, J. J., Davis, E. A., Sucov, A., et al. (1993) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-199301000-00008 · Cited by 128
Prediction of non-survival after trauma: Innsbruck Coma Scale
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Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication
Nolan, J. P., Neumar, R. W., Adrie, C., Aibiki, M., Berg, R. A., Böttiger, B. W., Callaway, C., Clark, R. S. B., Geocadin, R. G., Jauch, E. C., et al. (2008) · Resuscitation · doi:10.1016/j.resuscitation.2008.09.017 · Cited by 1,499
Neumar, R. W., Nolan, J. P., Adrie, C., Aibiki, M., Berg, R. A., Böttiger, B. W., Callaway, C., Clark, R. S. B., Geocadin, R. G., Jauch, E. C., et al. (2008) · Circulation · doi:10.1161/circulationaha.108.190652 · Cited by 1,436
Schnakers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S., Moonen, G., & Laureys, S. (2009) · BMC Neurology · doi:10.1186/1471-2377-9-35 · Cited by 1,348
Classification of traumatic brain injury for targeted therapies
Saatman, K. E., Duhaime, A.-C., Bullock, R., Maas, A. I. R., Valadka, A., & Manley, G. T. (2008) · Journal of Neurotrauma · doi:10.1089/neu.2008.0586 · Cited by 1,141
“Other neurological severity scales include the Brus-sells Coma Grades, Grady Coma Grades, Innsbruck Coma Scale, and the FOUR score scale (Brihaye et al., 1978; Fleischer et al., 1976; Gerstenbrand et al., 1970; Wijdicks et al., 2005).”
Nolan, J. P., Sandroni, C., Böttiger, B. W., Cariou, A., Cronberg, T., Friberg, H., Genbrugge, C., Haywood, K., Lilja, G., Moulaert, V. R. M., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06368-4 · Cited by 1,078
Metadata
- Authors
- Wijdicks, E. F. M., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L.
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2005-09-21
- Volume
- 58
- Issue
- 4
- Pages
- 585-593
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- OpenAlex
- W1996864068
- Cited by
- 1,122
- References
- 13
- FWCI
- 9.38
- Type
- journal article
- Language
- en
- Open access
- closed
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