In addition, the brainstem categories of the FOUR score rely on up to three different items (pupil, corneal, and cough reflex) whereas all categories of the GCS rely on one item only.
The exact inter-rater agreement was better for the FOUR score than for the GCS in the three predefined subgroups intubated patients (n = 60; 78% vs. 65%, P = 0.026), sedated patients (n = 52; 73% vs. 62%, P = 0.095), and patients with neurological disease as primary admittance diagnosis (n = 86; 80% vs. 69%, P = 0.046).
In the FOUR score, however, the inter-rater agreement significantly differed between the four components with the component 'respiration' achieving the highest agreement rates and the component 'brainstem' achieving the lowest agreement rates.
An increase in the FOUR Score (Full Outline of UnResponsiveness score) was observed in 50% of IS-trials by three twoo to four) points (P < 0.05).
An increase in the FOUR Score (Full Outline of UnResponsiveness score) was observed in 50% of IS-trials by a median of three twoo to four) points.
However, as raters performed the GCS and the FOUR score simultaneously such true alterations in the level of consciousness cannot explain the observed differences in the inter-rater agreement between the two scores.
Does the FOUR score correctly diagnose the vegetative and minimally conscious states?
Accordingly, a group of neurologists at the Mayo Clinic have proposed a new scale, known as the FOUR score -- for Full Outline of UnResponsiveness (Wijdicks et al., 2005).
The FOUR score assesses eye and motor responses, much as the GCS does; but instead of a verbal response, it assesses respiration and brainstem reflexes.
A young Peshawar journalist sits beside me, talking in a subdued but angry way, as if someone is listening to us, about the pilotless American aircraft which now slaughter by the score – or the four score – along the Afghanistan border.
Available at Fat-Shak now, the "Four Score and Seven Cent" QuickMeal includes quarter-pound Gettysburger with all the trimmings, souvenir cardboard stovepipe hat packed with fries, and a second hat containing a sixteen-ounce (fifteen-ounce in New York City) beverage.
