TY - JOUR
T1 - Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium
T2 - Interrater reliability and relation to outcome
AU - Gujjar, Arunodaya R.
AU - Jacob, Poovathru C.
AU - Nandhagopal, R.
AU - Ganguly, S. S.
AU - Obaidy, Ammar
AU - Al-Asmi, Abdullah R.
N1 - Funding Information:
This study was funded by the Sultan Qaboos University, Muscat, Oman. The authors wish to acknowledge and thank all the patients and their families for their kind cooperation, Dr Gousia Jikky for help in data collection and maintaining database, residents and SHOs in the Medicine Department for their enthusiastic participation, and nursing staff for their valuable support.
PY - 2013/6
Y1 - 2013/6
N2 - Purpose: Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score. Patients and Methods: Adult patients with altered mental status due to medical causes were rated by neurology consultants and internal medicine residents on FS and GCS. Interobserver reliability for GCS and FS was assessed using κ score. Relation with outcomes was explored using univariate and multivariate analyses. Main Results: Of the 100 patients (age, 62 ± 17 years), 60 had neurologic conditions; 26, metabolic encephalopathy; 9, infections; and 7, others. Thirty-nine patients died at 3 months κ Scores ranged from 0.71 to 0.85 for GCS and from 0.71 to 0.95 for FS. On multivariate analysis, GCS was predictive of outcome at 3 months; FS was predictive of mortality. Area under the receiver operating characteristic curves suggested equivalent performance of both scoring systems. Conclusions: Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
AB - Purpose: Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score. Patients and Methods: Adult patients with altered mental status due to medical causes were rated by neurology consultants and internal medicine residents on FS and GCS. Interobserver reliability for GCS and FS was assessed using κ score. Relation with outcomes was explored using univariate and multivariate analyses. Main Results: Of the 100 patients (age, 62 ± 17 years), 60 had neurologic conditions; 26, metabolic encephalopathy; 9, infections; and 7, others. Thirty-nine patients died at 3 months κ Scores ranged from 0.71 to 0.85 for GCS and from 0.71 to 0.95 for FS. On multivariate analysis, GCS was predictive of outcome at 3 months; FS was predictive of mortality. Area under the receiver operating characteristic curves suggested equivalent performance of both scoring systems. Conclusions: Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
KW - Coma
KW - Coma score
KW - FOUR score
KW - Full Outline of Unresponsiveness
KW - Glasgow Coma Scale
KW - SOFA score
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U2 - 10.1016/j.jcrc.2012.06.009
DO - 10.1016/j.jcrc.2012.06.009
M3 - Article
C2 - 22884530
AN - SCOPUS:84876829023
SN - 0883-9441
VL - 28
SP - 316.e1-316.e8
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 3
ER -