Reliability of the Turkish Version of a New Coma Scale: FOUR Score

Objectives: Although the most commonly used scale is the Glasgow Coma Scale (GCS) in neurological intensive care units (NICU), it has some shortcomings. Many attempts have been made to design new scales that could provide further neurological detail in coma. The FOUR score (Full Outline of UnResponsiveness) is a new coma scale. The aim of this study is the validation of the Turkish version of the FOUR score and comparison of it with the GCS.Patients and Methods: A total of consecutive 124 patients (65 males, 59 females; mean age 68.4±14.7 years; range 26 to 96 years) who were admitted to the seven NICUs between 2006-2007 were enrolled in the study. Each patient was rated on both scales by two different neurologists within one hour after each other without knowledge of the other's scores. Morbidity was assessed at hospital discharge using the modified Rankin Scale.Results: The inter-rater reliability was excellent for both FOUR score (K=0.68; %95 CI, 0.59-077) and GCS (K=0.69; %95 CI, 0.60-0.77). Outcome prediction of the FOUR score was as effective as GCS.Conclusion: The FOUR score has major advantages and provide important details of the neurologic examination such as brainstem reflexes and eye movements. We believe our results suggest that the FOUR score could be used instead of GCS in the NICUs in Turkey.