Interrater reliability and predictive validity of the FOUR score coma scale in a pediatric population

Abstract

The Glasgow Coma Scale (GCS) was developed in 1974 to objectively describe neurological status and predict outcome in neuroscience patients. Through the years, the GCS has become the gold standard for coma assessment. Despite its widespread use, the GCS has many limitations that are well documented in the literature. The Full Outline of Unresponsiveness (FOUR) score is a new coma scale that was recently developed and validated in adults as a proposed replacement for the GCS. The purpose of this study was to compare the interrater reliability and predictive validity of the FOUR score and the GCS in pediatric patients. The interrater reliability for the GCS was good (k(w) = .738), and that for the FOUR score was excellent (k(w) = .951). Outcome prediction analysis showed that the FOUR score and the GCS are both able to predict in-hospital morbidity and poor outcome at the end of hospitalization. The results from this pediatric study were consistent with the adult studies which suggest that the FOUR score is a reliable and valid tool for use in a wide variety of neuroscience patients.