Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN

El Departamento de Neurología del Hospital La Paz ( Madrid ) ha publicado en el número 63-6 del European Journal of Neurology la validación de la Escala Four (Full Outline of UnResponsiveness) . Esta escala fue desarrollada por el From the Divisions of Critical Care Neurology de la Clínica Mayo para hacer frente a las deficiencias de las escalas al uso ( Glasgow y NIHS) para valorar el nivel de conciencia en los pacientes con ictus, afectados con frecuencia por transtornos del lenguage. La escala evalua 4 áreas: respuesta ocular, motora, reflejos de tronco ( pupilar y tusígeno) y respiración con una puntuación de 1 a 4 en cada apartado. En el estudio los investigadores encuentran un acuerdo interobservador excelente y una muy buean correlación con le escala de coma de Glasgow y la escala NIH.

Eur Neurol. 2010 Jun 16;63(6):364-369. [Epub ahead of print]
Validation of the FOUR Score (Spanish Version) in Acute Stroke: An Interobserver Variability Study.
Idrovo L, Fuentes B, Medina J, Gabaldón L, Ruiz-Ares G, Abenza MJ, Aguilar-Amat MJ, Martínez-Sánchez P, Rodríguez L, Cazorla R, Martínez M, Tafur A, Wijdicks EF, Diez-Tejedor E.

Department of Neurology, Stroke Unit, La Paz University Hospital, Autonoma University of Madrid, IdiPAZ, Madrid, Spain.
Abstract
Background: Methods to assess impaired consciousness in acute stroke typically include the Glasgow Coma Scale (GCS), but the verbal component has limitations in aphasic or intubated patients. The FOUR (Full Outline of UnResponsiveness) score, a new coma scale, evaluates 4 components: eye and motor responses, brainstem reflexes and respiration. We aimed to study the interobserver variability of the FOUR score in acute stroke patients. Methods: We prospectively enrolled consecutive patients with acute stroke admitted from February to July 2008 to the stroke unit of our Neurology Department. Patients were evaluated by neurology residents and nurses using the FOUR score and the GCS. For both scales, we obtained paired and total weighted kappa values (Kw) and intraclass correlation coefficients (ICC). NIH stroke scale was also recorded on admission. Results: We obtained a total of 75 paired evaluations in 60 patients (41 cerebral infarctions, 15 cerebral hemorrhages and 4 transient ischemic attacks). Thirty-three (55%) patients were alert, 17 (28.3%) drowsy and 10 (16.7%) stuporous or comatose. The overall rater agreement was excellent in the FOUR score (Kw 0.93; 95% CI 0.89-0.97) with an ICC of 0.94 (95% CI 0.91-0.96) and in the GCS (Kw 0.96; 95% CI 0.94-0.98) with an ICC of 0.96 (95% CI 0.93-0.97). A good correlation was found between the FOUR score and the GCS (rho 0.83; p < 0.01) and between the FOUR score and the NIH stroke scale (rho -0.78; p < 0.001). Conclusions: The FOUR score is a reliable scale for evaluating the level of consciousness in acute stroke patients, showing a good correlation with the GCS and the NIH stroke scale. Copyright © 2010 S. Karger AG, Basel.