Reliability and validity of the application of two consciousness assessment scales in neurosurgical patients / 中国实用护理杂志

ABSTRACT

Objective To compared the reliability and validity of the application of two consciousness assessment scales in neurosurgical patients by Full Outline of Unresponsiveness Score Coma Scale (FOUR) and the Glasgow Coma Scale (GCS), and provide the effective evaluation for the consciousness of the nerve severe patients. Methods A total of 100 neurological intensive patients from Nanfang Hospital, Southern Medical University were enrolled and the consciousness was evaluated by FOUR and GCS. The reliability and validity of these scales were evaluated and compared by the following method such as Cronbach αcoefficient, the inter-rater agreement,content validity index (CVI) and the receiver operating characteristic curve (ROC) which used to predict the discrimination of prognosis.The important experimental indexes of blood of the degree of brain injury were collected in the same periodS-100 B protein and neuron specific enolization enzymes (NSE). Results The Cronbach α coefficient was 0.811 (FOUR) and 0.923(GCS). The overall rater agreement was excellent with an intraclass correlation coefficients of 0.972 (FOUR) and 0.979(GCS). CVI was 0.965 (FOUR) and 0.973 (GCS). Both scales had better distinguish and predictive abilities for the poor prognosis.The area under the curve for mortality was 0.938 for the FOUR and 0.932 for the GCS. The best cut-off values for predicting poor prognosis were FOUR of 12 and GCS of 11. For the FOUR, the correlation coefficient was-0.324(P<0.05) with the level of NSE,-0.427(P<0.01) with the level of S-100B protein. For the GCS,the correlation coefficient was-0.316 (P<0.05) with the level of NSE,-0.395 (P<0.01) with the level of S-100B protein. Conclusions Both FOUR and GCS are a reliable scale for evaluating the level of consciousness in neurosurgical patients. The GCS is familiar with the medical staff while the FOUR is more adapted to assess the patients with tracheotomy or intubated and which more easy to remember and learn by medical staff of neurosurgery department.