Background
Methods
Development of the Chinese version of the FOUR Score
FOUR Score | |
---|---|
Eye response | Brainstem reflexes |
4: eyelids open or opened, tracking, or blinking to command | 4: pupil and corneal reflexes present |
3: eyelids open but not tracking | 3: one pupil wide and fixed |
2: eyelids closed but open to loud voice | 2: pupil or corneal reflexes absent |
1: eyelids closed but open to pain | 1: pupil and corneal reflexes absent |
0: eyelids remain closed with pain | 0: absent pupil, corneal, and cough reflex |
Motor response | Respiration |
4: thumbs-up, fist, or peace sign | 4: not intubated, regular breathing pattern |
3: localizing to pain | 3: not intubated, Cheyne–Stokes breathing pattern |
2: flexion of the upper limbs response to pain | 2: not intubated, irregular breathing |
1: extension of the upper limbs response to pain | 1: breathes above ventilator rate |
0: no response to pain or generalized myoclonus status | 0: breathes at ventilator rate or apnea |
无反应性全面量表 | |
---|---|
眼睛反应 | 脑干反射 |
4分:眼睑张开或被张开,且眼球跟随物体移动,或随指令眨眼 | 4分:瞳孔和角膜反射均存在 |
3分:眼睑张开但眼球不跟随移动 | 3分:一侧瞳孔放大和固定 |
2分:眼睑闭合但大声呼唤时睁眼 | 2分:瞳孔或角膜反射其中一项消失 |
1分:眼睑闭合但疼痛刺激时睁眼 | 1分:瞳孔和角膜反射均消失 |
0分:疼痛刺激时仍保持眼睑闭合 | 0分:瞳孔反射、角膜反射和咳嗽反射均消失 |
运动反应 | 呼吸 |
4分:可竖起拇指、握拳或做V字手势 | 4分:无气管插管,呼吸节律规则 |
3分:疼痛刺激时能定位 | 3分:无气管插管,潮式呼吸 |
2分:疼痛刺激时上肢屈曲 | 2分:无气管插管, 呼吸不规则 |
1分:疼痛刺激时上肢伸直 | 1分:呼吸频率大于机械通气频率 |
0分:疼痛刺激时无反应或全身呈肌阵挛状态 | 0分:呼吸机控制呼吸或呼吸暂停 |
Reliability and validity assessment of the Chinese version of the FOUR score
Patients
Procedure
Outcome assessment
Statistical analyses
Results
Characteristics of the patients
Statistics/category | Frequency |
---|---|
Age (years), mean ± SD | 47.9 ± 14.8 |
Gender, male, n (%) | 85 (70.8 %) |
Diagnosis, n (%) | |
TBI | 53 (44.2 %) |
Intracerebral hemorrhage | 38 (31.7 %) |
Subarachnoid hemorrhage | 22 (18.3 %) |
Brain tumor | 3 (2.5 %) |
Hydrocephalus | 2 (1.7 %) |
Epilepsy | 1 (0.8 %) |
Cerebral infarction | 1 (0.8 %) |
Outcome, n (%) | |
Good outcome (MRS, 0-2) | 42 (35 %) |
Poor outcome (MRS, 3-6) | 78 (65 %) |
In-hospital death | 26 (21.7 %) |
Consciousness, n (%) | |
Alert | 33 (27.5 %) |
Drowsy | 28 (23.3 %) |
Stuporous | 44 (36.7 %) |
Comatose | 15 (12.5 %) |
FOUR and GCS scores
Rater Pair | No. of patients | FOUR score | GCS | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Eye | Motor | Brainstem | Respiration | Total | Eye | Motor | Verbal | Total | ||
R/R | 40 | 0.988 | 0.993 | 0.928 | 0.987 | 0.991 | 0.958 | 0.934 | 0.961 | 0.971 |
N/N | 47 | 0.928 | 0.968 | 0.919 | 0.955 | 0.973 | 0.933 | 0.894 | 0.893 | 0.949 |
N/R | 33 | 0.764 | 0.939 | 0.779 | 0.895 | 0.929 | 0.906 | 0.831 | 0.863 | 0.940 |
0veral | 120 | 0.932 | 0.970 | 0.885 | 0.941 | 0.970 | 0.939 | 0.900 | 0.914 | 0.958 |
Intraclass correlation
Patients (n) | FOUR score (95 % CI) | GCS (95 % CI) |
---|---|---|
Consciousness | ||
Alert (33) | 0.888 (0.776–0.945) | 0.712 (0.422–0.857) |
Drowsy (28) | 0.696 (0.351–0.859) | 0.761 (0.489–0.889) |
Stuporous (44) | 0.891 (0.801–0.940) | 0.521 (0.126–0.738) |
Comatose (15) | 0.879 (0.649–0.959) | 0.696 (0.122–0.897) |
Diagnosis | ||
TBI (53) | 0.977 (0.959–0.986) | 0.956 (0.924–0.975) |
Non-TBI (67) | 0.964 (0.941–0.978) | 0.959 (0.934–0.975) |
Intubation | ||
Intubated (58) | 0.940 (0.899–0.965) | 0.858 (0.760–0.916) |
Non-intubated (62) | 0.956 (0.927–0.973) | 0.953 (0.922–0.972) |
Consistency
Prognosis
Variable | Hospital mortality AUC (95 % CI) | MRS 3-6 AUC (95 % CI) |
---|---|---|
Total FOUR score | 0.834 (0.740–0.928) | 0.818 (0.742–0.894) |
Eye | 0.758 (0.661–0.855) | 0.788 (0.699–0.877) |
Motor | 0.789 (0.681–0.896) | 0.785 (0.701–0.869) |
Brainstem reflexes | 0.764 (0.656–0.872) | 0.708 (0.616–0.799) |
Respiration | 0.692 (0.561–0.824) | 0.596 (0.495–0.698) |
Total GCS | 0.815 (0.723–0.908) | 0.812 (0.734–0.891) |
Eye | 0.771 (0.681–0.861) | 0.786 (0.698–0.874) |
Motor | 0.731 (0.633–0.829) | 0.796 (0.713–0.879) |
Verbal | 0.793 (0.689–0.897) | 0.780 (0.697–0.863) |