Validation of the Italian version of a new coma scale: the FOUR score
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The Glasgow Coma Scale (GCS) is the most widely accepted tool for the evaluation of consciousness, despite several reported shortcomings. A new coma scale, named Full Outline of UnResponsiveness (FOUR) score, is now available. The aim of the present study is to provide and validate the Italian version of the FOUR score. The Italian version of the FOUR score was developed according to a standardized protocol, and thereafter validated in a series of patients with acute neurological illness. For each patient, the FOUR and the GCS scores were recorded by two physicians randomly selected. The inter-rater agreement for the FOUR and the GCS scores was evaluated using the weighted kappa (κw). The receiving operating characteristic curve was also calculated to determine the ability of the scales to predict outcome. Eighty-seven consecutive patients with an acute brain injury were enrolled. The inter-rater agreement was excellent both for the FOUR (κw = 0.953; P < 0.0001) and the GCS (κw = 0.943; P < 0.01). The area under the curve for mortality was 0.935 for the FOUR and 0.953 for the GCS. The FOUR score provides greater neurological details than the GCS. Our data indicate that the Italian version of the FOUR score is a valid predictor of outcome, yielding reproducible findings across raters independent of their expertise.
KeywordsFull Outline of UnResponsiveness score Acute brain injury Coma scale Outcome predictor Glasgow Coma Scale
We are grateful to Angelo G. Blasetti, Renato Galzio, Tullio Pozone, Gustavo Spadetta and all their staff for kindly supporting the study.
Conflict of interest
- 5.Stanczak DE, White JG 3rd, Gouview WD, Moehle KA, Daniel M, Novack T, Long CJ (1984) Assessment of level of consciousness following severe neurological insult. A comparison of the psychometric qualities of the Glasgow Coma Scale and the Comprehensive Level of Consciousness Scale. J Neurosurg 60:955–960PubMedCrossRefGoogle Scholar
- 17.Idrovo L, Fuentes B, Medina J, Gabaldón L, Ruiz-Ares G, Abenza MJ, Aguilar-Amat MJ, Martínez-Sánchez P, Rodríguez L, Cazorla R, Martínez M, Tafur A, Wijdicks EF, Diez-Tejedor E (2010) Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study. Eur Neurol 63:364–369PubMedCrossRefGoogle Scholar