Volume 14, Issue 8 (October 2020)                   Qom Univ Med Sci J 2020, 14(8): 1-9 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Kimiaei Assadi H, Shirmohammadi N. Standardization of Full Outline of Unresponsiveness Scale to Assess the Level of Consciousness of the Patients Hospitalized in the Intensive Care Unit in Iran. Qom Univ Med Sci J 2020; 14 (8) :1-9
URL: http://journal.muq.ac.ir/article-1-2838-en.html
Standardization of Full Outline of Unresponsiveness Scale to Assess the Level of Consciousness of the Patients Hospitalized in the Intensive Care Unit in Iran
Hossein Kimiaei Assadi1 , Nasrin Shirmohammadi * 2
1- Anesthesiology Department, Hamadan University of Medical Sciences
2- MSc in Biostatistics, Faculty of Health Sciences, Hamadan University of Medical Sciences , hosseiny.samane@gmail.com
Abstract:   (2673 Views)
Background and Objectives: The Full Outline of Un-Responsiveness (FOUR) scale is a tool to assess the consciousness level in patients admitted to the Intensive Care Units (ICU). The validity and reliability of this scale can be affected by distorting factors, such as social, cultural, biological, and physiological conditions. This study aimed to evaluate the standardization of the FOUR scale to assess the consciousness level of the patients based on demographic characteristics in the Iranian population.
 
Methods: This experimental cross-sectional study was conducted on 60 patients hospitalized in the ICU. The FOUR scale was used to determine the consciousness level of the patients. Reliability, internal consistency, as well as correlations between the scales were estimated using Cronbach's alpha and Spearman-Brown formula. The data were analyzed in SPSS software (version 16.0) (SPSS Inc., Chicago, Illinois, USA). A p-value less than 0.05 was considered statistically significant.
 
Results: According to the results, the internal consistency values of the Glasgow Coma Scale (GCS) and FOUR scale were estimated at 0.943 and 0.889, respectively, using Cronbach's alpha. In addition, there was a significant correlation between the FOUR scale and GCS (r=0.948, P=0.001).  Furthermore, the sum of sensitivity and specificity of the total score of the FOUR scale and GCS were obtained at 5 (sensitivity=0.72; specificity=31.43) and 7 (sensitivity=0.68; specificity=0.3714), respectively. In addition, the Area under the ROC Curve value in predicting in-hospital mortality for the FOUR scale was 0.491 (P=0.910 and 95% CI: 0.338-0.645), while it was obtained at 0.527 (P=0.725 and 95% CI: 0.374-0.679) for the GCS.
 
Conclusion: The results revealed that the GCS could be used as a standard scale to assess the consciousness level of the patients. The FOUR scale and GCS have similar benefits, and the former is a valuable tool to assess the consciousness level due to the combination of eye and motor components. Therefore, GCS could be used as substitute for the FOUR scale. 

                    



                    




                    

                    Keywords:  Consciousness, Full outline of unresponsiveness, Glasgow coma scale, Comatose patients
                    






                    

                    
                    Full-Text [PDF 824 kb]  
                    
                    
                     



                     

                    
                       (870 Downloads)  


                        

                        



                    
                    



                    




                    

                    Type of Study:  Original Article |
                    Subject: 
                    بیوشیمی بالینی-عمومی  
Received: 2020/06/13 | Accepted: 2020/09/9 | Published: 2020/11/30
                    



                    

                    
                    


                    









                    

                    

                    References
                    

                    

                    
1. Posner JB, Plum F. Plum and Posner's diagnosis of stupor and coma. New York: OUP USA; 2007. Link [DOI:10.1093/med/9780195321319.001.0001] 
2. Stevens RD, Bhardwaj A. Approach to the comatose patient. Crit Care Med 2006;34(1):31-41. PMID: 16374153 [DOI:10.1097/01.CCM.0000194534.42661.9F] 
3. Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010;362(7):579-89. PMID: 20130250 [DOI:10.1056/NEJMoa0905370] 
4. Peng J, Deng Y, Chen F, Zhang X, Wang X, Zhou Y, et al. Validation of the Chinese version of the FOUR score in the assessment of neurosurgical patients with different level of consciousness. BMC Neurol 2015;15(1):254. PMID: 26652248 [DOI:10.1186/s12883-015-0508-9] 
5. Muniz EC, Thomaz MC, Kubota MY, Cianci L, de Sousa RM. Use of the Glasgow coma scale and the jouvet coma scale to evaluate the level of consciousness. Rev Esc Enferm USP 1997;31(2):287-303. PMID: 9411580 [DOI:10.1590/S0080-62341997000200010] 
6. Sadaka F, Patel D, Lakshmanan R. The FOUR score predicts outcome in patients after traumatic brain injury. Neurocrit Care 2012;16(1):95-101. PMID: 21845490 [DOI:10.1007/s12028-011-9617-5] 
7. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005;58(4):585-93. PMID: 16178024 [DOI:10.1002/ana.20611] 
8. Balestreri M, Czosnyka M, Chatfield D, Steiner L, Schmidt E, Smielewski P, et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 2004;75(1):161-2. PMID: 14707332
9. 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. Eur J Emerg Med 2009;16(1):29-36. PMID: 19106717 [DOI:10.1097/MEJ.0b013e32830346ab] 
10. Murthy TV. A new score to validate coma in emergency department-FOUR score. Indian J Neurotrauma 2009;6(1):59-61. Link [DOI:10.1016/S0973-0508(09)80028-2] 
11. Bruno MA, Ledoux D, Lambermont B, Damas F, Schnakers C, Vanhaudenhuyse A, et al. Comparison of the full outline of unresponsiveness and glasgow liege scale/glasgow coma scale in an intensive care unit population. Neurocrit Care 2011;15(3):447-53. PMID: 21526394 [DOI:10.1007/s12028-011-9547-2] 
12. Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EF. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc 2009;84(8):694-701. PMID: 19648386 [DOI:10.4065/84.8.694] 
13. Tadrisi SD, Bahari N, Ebadi A, Madani SJ. Validity and reliability of coma scale (four score) in adult patient hospitalized in Critical Care Units. Iran J Crit Care Nurs 2012;5(2):95-102. Link
14. Cohen J. Interrater reliability and predictive validity of the FOUR score coma scale in a pediatric population. J Neurosci Nurs 2009;41(5):261-7. PMID: 19835239 [DOI:10.1097/JNN.0b013e3181b2c766] 
15. Idrovo L, Fuentes B, Medina J, Gabaldón L, Ruiz-Ares G, Abenza MJ, et al. Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study. Eur Neurol 2010;63(6):364-9. PMID: 20551672 [DOI:10.1159/000292498] 
16. Wolf CA, Wijdicks EF, Bamlet WR, McClelland RL. Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clin Proc 2007;82(4):435-8. PMID: 17418071 [DOI:10.4065/82.4.435] 
17. Stead LG, Wijdicks EF, Bhagra A, Kashyap R, Bellolio MF, Nash DL, et al. Validation of a new coma scale, the FOUR score, in the emergency department. Neurocriti Care 2009;10(1):50-4. PMID: 18807215 [DOI:10.1007/s12028-008-9145-0] 
18. 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. Crit Care 2010;14(2):R64. PMID: 20398274 [DOI:10.1186/cc8963] 
19. Weiss N, Mutlu G, Essardy F, Nacabal C, Sauves C, Bally C, et al. The French version of the FOUR score: a new coma score. Rev Neurol 2009;165(10):796-802. PMID: 19296997 [DOI:10.1016/j.neurol.2009.01.045] 
20. Pishgooie SA, Zareiyan A, Tadrisi SD. Inter-rater reliability of the modified and original FOUR coma scale in patients hospitalized in critical care unit. Razi J Med Sci 2015;21(128):85-90. Link

                    

                    

                    









                    





                    

                    

                    Add your comments about this article : Your username or Email:
                    
                    

                    
                    




                    


				  
 CAPTCHA


	

 

				  
 


                    
                    


                    

                    






                    

                    

                    Send email to the article author
                    

                    

                    

                    
                    

                    
                    

                    

                    

                    




                    




                    












                    

                    

	
		

			Rights and permissions
		

		

			Creative Commons License 
			This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
		

	



                    

                    























                 


              


              


















		
	









  

   


© 2025 CC BY-NC 4.0 | Qom University of Medical Sciences Journal



Designed & Developed by : Yektaweb