Variation Among Evaluators of The Full Outline of Unresponsiveness Score and The Glasgow Coma Scale in Critically Ill Patients- A Prospective Study

Year 2024, Volume: 34 Issue: 6, 861 - 866, 31.12.2024

Yeşim Şerife Bayraktar , Yasemin Cebeci , Büşra Pekince , Dilara Cari Güngör , Muslu Kazım Körez , Faruk Çiçekci , Jale Bengi Çelik

https://doi.org/10.54005/geneltip.1551859

Abstract

Abstract
Background/Aims: This study aims to compare the reliability of the FOUR (Full Outline of Unresponsiveness) score and GCS (Glasgow Coma Score) when used by specialists from different medical disciplines.
Methods: This prospective observational study was conducted at Selçuk University Faculty of Medicine between December 2023 and June 2024. Eighty-two patients in the Anesthesiology and Reanimation Intensive Care Unit (ICU) were assessed by three specialists—a pulmonologist, a neurologist, and an anesthesiologist—within 24 hours of ICU admission. The variation between evaluators of both scoring systems was analyzed using the Intraclass Correlation Coefficient (ICC). If the ICC coefficient was below 0.50, the agreement was interpreted as poor.
Results: The study included 82 patients. There were no statistically significant differences in the FOUR and GCS scores assigned by the three specialists. The mortality rate among patients with low scores on both FOUR and GCS was higher than the hospital mortality rate.
Conclusions: Scales used in the ICU should be simple, reliable and predictive. This study demonstrated that the FOUR score is at minimum equivalent to the GCS in meeting these criteria.

Keywords

Scale, Glasgow Coma Scale, Reliability, APACHE, Critical Care

References

• 1. Bayraktar YS, Sahinoglu M, Cicekci F, Kara I, Karabagli H, Duman A, Celik JB. Comparison of Glasgow coma scale and full outline of unresponsiveness (Four) score: a prospective study. Turk Neurosurg. 2019;29(2):285-8.
• 2. McNett M, Amato S, Gianakis A, Grimm D, Philippbar SA, Belle J, Moran C. The FOUR score and GCS as predictors of outcome after traumatic brain injury. Neurocritical care. 2014;21:52-7.
• 3. Kramer AA, Wijdicks EF, Snavely VL, Dunivan JR, Naranjo LLS, Bible S, et al. A multicenter prospective study of interobserver agreement using the Full Outline of Unresponsiveness score coma scale in the intensive care unit. Critical care medicine. 2012;40(9):2671-6.
• 4. KARABIYIK L. Intensive care scoring systems. J Med Surg Intensive Care Med. 2010;9.
• 5. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. The Lancet. 1974;304(7872):81-4.
• 6. Manley GT, Maas AI. The Glasgow Coma Scale at 50: looking back and forward. The Lancet. 2024;404(10454):734-5.
• 7. Jalali R, Rezaei M. A comparison of the Glasgow Coma Scale score with a full outline of unresponsiveness scale to predict patients’ traumatic brain injury outcomes in intensive care units. Critical care research and practice. 2014;2014(1):289803.
• 8. Fischer M, Rüegg S, Czaplinski A, Strohmeier M, Lehmann A, Tschan F, et al. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Critical care. 2010;14:1-9.
• 9. Temiz NC, Kose G, Tehli O, Acikel C, Hatipoglu S. A comparison between the effectiveness of full outline of unresponsiveness and Glasgow coma score at neurosurgical intensive care unit patients. Turk Neurosurg. 2018;28(2):248-50.
• 10. Örken DN, Sağduyu AK, Şırın H, Işikara CT, Gökçe M, Sütlaş N, et al. Yeni Bir Koma Değerlendirme Ölçeği Olan FOUR Skorun Türkçe çevirisinin Güvenirlik çalışması. Medical Journal of Trakya University/Trakya Universitesi Tip Fakultesi Dergisi. 2010;27(1).
• 11. Koo TK, Li MY. A guideline for selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.
• 12. Okasha AS, Fayed AM, Saleh AS. The FOUR score predicts mortality, endotracheal intubation, and ICU length of stay after traumatic brain injury. Neurocritical care. 2014;21:496-504.
• 13. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2005;58(4):585-93.
• 14. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349-53.
• 15. Schnakers C, Giacino J, Kalmar K, Piret S, Lopez E, Boly M, et al. Does the FOUR score correctly diagnose the vegetative and minimally conscious states? Annals of neurology. 2006;60(6).
• 16. Eken C, Kartal M, Bacanli A, Eray O. Comparison of the Full Outline of Unresponsiveness Score Coma Scale and the Glasgow Coma Scale in an emergency setting population. European journal of emergency medicine. 2009;16(1):29-36.
• 17. Şahin AS, Şahin M, Öztürk NK, Kızılateş E, Karslı B. Comparision Of GCS And FOUR Scores Used In The Evaluation Of Neurological Status In Intensive Care Units Yoğun Bakım Ünitelerinde Nörolojik Durumun Değerlendirilmesinde Kullanılan GKS ve FOUR Skorlarının Karşılaştırılması. Journal of Contemporary Medicine. 2015;5(3).