gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness

Validierung eines neuen neurologischen Scores (FOUR Score) zur Beurteilung hochgradig bewusstseinsgetrübter neurochirurgischer Patienten

Meeting Abstract

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  • corresponding author B. Chen - Neurochirurgische Universitätsklinik Bonn
  • C. Grothe - Neurochirurgische Universitätsklinik Bonn
  • C. Schaller - Neurochirurgische Universitätsklinik Bonn

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.07.03

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Veröffentlicht: 11. April 2007

© 2007 Chen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Assessment of neurological status is an important tool in predicting outcome in patients with severely impaired consciousness. The Glasgow Coma Scale (GCS) as the most prevalent scoring system lacks reliability, as it does not allow for testing of brainstem reflexes, and is unable to assess verbal scores in intubated patients. This study aims to validate the recently introduced FOUR (Full Outline of UnResponsiveness) score.

Methods: This prospective non-randomized neurological study currently includes n=50 patients (24 f, 26 m), who were treated within a six-month-period at a neurosurgical intensive care unit. The patients were aged 13-86 (mean: 62) years and suffered from traumatic brain injury, or from spontaneous intracranial haemorrhage, including subarachnoid haemorrhage. The FOUR score consists of the components eye, motor, brainstem and respiration, each of them having a top score of 4 for the best result. Patients were assessed by the FOUR score and the GCS at the same time. Both scores were compared according to the Glasgow Outcome Score (GOS) 30 days after the primary examination.

Results: 34% of the patients were dead (GOS 1), and 14% patients had a poor outcome (GOS 2) at 30 days. Median values at primary examination were 6 (range: 0-13) for the FOUR score, and 5.5 (range: 3-10) for the GCS. Low FOUR scores (0-8) were a significantly stronger predictor for mortality than low GCS values (3-8).

Conclusions: The FOUR score is easy to apply and is a reliable instrument for assessing states of impaired consciousness. In comparison to the GCS, it is superior with respect to assessment of low levels of consciousness. It has a particularly high reliability in predicting non-survival after one month, but a long-term outcome study is still needed.