A Research On Value Of Full Outline Of Unresponsiveness Scale In Evaluating Functional Recovery In Patients With Consciousness Disorder

Objective:Taking Glasgow Coma Scale (GCS) as reference, to explore the prognostic value of Full Outline of Unresponsiveness (FOUR) scale for the acute stroke patients with consciousness disorder, and further to provide a suitable assessment method for ICU clinicians.Methods:A total of 98 patients with acute stroke along with consciousness disturbance in EICU of Jiangsu Province Hospital were included. Three evaluation groups assessed the same subjects using GCS and FOUR after acute stroke occurrence. Team A, B, C consisted of a nurse experienced less than 5 years, a nurse experienced more than 5 years, and a doctor, respectively. In addition, another doctor reassessed the subjects 30,60 and 90 days later, using Modified Rankin Scale (MRS). The main research contents including:1. Compare the difference in basic condition and assessment grading between cerebral hemorrhage and cerebral infarction,2. Observe differences of assessment results in GCS and FOUR scales among the three Teams,3. Survey the inter-scorers reliability and internal consistency of the GCS and FOUR scales,4. Analyze the relationship between the GCS, FOUR scales and MRS,4. Compare the accuracy, discriminability between the GCS and FOUR scales, and gain the optimal cut-off value to predict the prognosis.Results:MRS results indicated that no significant difference in age, gender, methcanical ventilation or not, GCS grading, FOUR grading and the three time points (P>0.05). The results in the GCS and FOUR scales assessment in three teams were similar (P>0.05). Kappa value of the GCS and FOUR scales were 0.752 and 0.803, while Cronbach’s a value were 0.839 and 0.856. The relationship value (r value) between the GCS and MRS scales were -0.767,-0.784 and-0.805. Both scales negatively correlated with mRS and more significant with progressing. The GCS and FOUR scales performed a similar accuracy and discriminability. According to Youden index, the the optimal cut-off value to predict the prognosis was 7 points,6 points and 5 points in GCS scale and 9 points,8 points and 7 points in FOUR scale on 30 days,60 days and 90 days after disease occurrence.Conclusion:Referring to GCS, FOUR scale could have a better credibility and effectiveness than the classical GCS assessment to predict the prognosis of the acute stroke patients with consciousness disorder. The best cutoff point of FOUR scale for predicting functional recovery would change with various assessment time point, as the same as the GCS scale.