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Neuro/Trauma Intensive Care Unit Nurses Perception of the Use of the Full Outline of Unresponsiveness Score Versus the Glasgow Coma Scale When Assessing the Neurological Status of Intensive Care Unit Patients

Johnson, Valerie D. RN, BSN; Whitcomb, John PhD, RN, CCRN, FCCM

Dimensions of Critical Care Nursing: July/August 2013 - Volume 32 - Issue 4 - p 180–183
doi: 10.1097/DCC.0b013e3182998082
Research DIMENSION

Introduction: This study compares the Full Outline of Unresponsiveness (FOUR) Score scale with the Glasgow Coma Scale (GCS) when evaluating a patient’s level of responsiveness in the neuro/trauma intensive care unit of a large medical center. This new scoring tool evaluates 4 functional categories: eye response, motor response, brainstem reflexes, and respiratory pattern.

Aims and Methods: A total of 57 patients 18 years or older were randomly selected as a convenience sample of those admitted to the neuro/trauma intensive care unit and were assessed using both the standard GCS and the FOUR Score scale. The raters then completed a short survey (43 completed) to compare the 2 tools.

Results: Rater agreement was very good with the FOUR Score scale and for the GCS; however, nurses favored the use of the FOUR Score scale (81.4%) over the GCS (0.00%) to assess the neurological responsiveness of their patients as the generally accepted assessment tool.

Conclusion: The FOUR Score scale provides a reliable neurological assessment of intubated patients where the GCS does not differentiate patient status once intubated.

This study compares the FOUR (Full Outline of Unresponsiveness) Score Scale to the GCS (Glasgow Coma Scale) when evaluating the patient’s level of responsiveness in the neuro/trauma intensive care unit of a large medical center. This new scoring tool evaluates 4 functional categories: eye response, motor response, brainstem reflexes, and respiratory pattern.

Valerie D. Johnson, RN, BSN, is a Hospital Development Coordinator at LifePoint Inc. She graduated from Pensacola Christian College in 1990; worked in Medical ICU at Johns Hopkins University Hospital, ICU/CCU at St. Francis of Greenville and the Neuro/Truama ICU at Greenville Memorial Hospital and served on the nursing faculty at Bob Jones University. Her research interest is organ perfusion post recovery for more successful recipient recovery.

John Whitcomb, PhD, RN, CCRN, FCCM, is assistant professor at Clemson University School of Nursing. His research focus is resuscitative outcomes.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Valerie D. Johnson, RN, BSN, 3950 Faber Place Suite 400, Charleston, SC 29405 (Johnsonv@LifePoint-SC.org).

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins