RESUMO
The Glasgow Coma Scale (GCS) is a widely adopted clinical scale which fails to assess a verbal component in intensive care units (ICUs) patients who are ventilated mechanically. AIM: The aim of the study was to evaluate the validity of the FOUR scale (Full Outline of UnResponsivness) when applied by staff of an ICU. MATERIALS AND METHODS: This prospective cohort study included 65 consecutive intubated patients treated in the ICU with brain damage. The study design included the simultaneous assessment of the patients' consciousness by two scales - the FOUR scale and the GCS. All assessments were made under strict inclusion and exclusion criteria. The patients were assessed by a randomly selected staff pairs (neurointensivist/ nurse, neurointensivist/resident, neurointensivist/neurointensivists). The assessments made by experienced neurointensivists were regarded as basic examinations and by other members as control examinations. The study design allowed for the assessment of the interrater reliability. RESULTS: In 65 enrolled patients, a total of 763 double assessments were made using the FOUR score and by the GCS. It has been shown that in 751 out of 763 assessments the patients' consciousness was accurately assessed, representing 98.43 % accuracy of the FOUR scale. In contrast, the patients' consciousness was reliably assessed by the GCS in only 88 assessments, representing 11.5 % of accuracy. CONCLUSIONS: The study showed excellent interrater reliability among the groups of examiners for the FOUR scale as well as the GCS. The main advantage of the FOUR scale in intubated patients is excellent accuracy. The FOUR scale is easy to learn. It is functional and it has no limitations typical of verbal scales. It is a valuable and recommended clinical tool for the assessment of consciousness of the ICU patients.
