The first experience of application of “full outline of unresponsiveness” (FOUR SCALE) in patients with acute cerebral insufficiency. Two-center research “FOUR-Rus”. Two-center trial

Abstract

Background. Analysis of distribution of Full Outline of UnResponsiveness (FOUR) Scale provided by F. M. Wijdicks at the Mayo Clinic in 2005 served as the basis for the initiation of the Federation of anesthesiologists of Russia study “FOUR-Rus” (NCT04018989 ClinicalTrails.gov). Objectives. To assess reproducibility and consistency when using the Russian-language version of the FOUR scale. Materials and methods. 260 patients were selected, aged 37 to 90 years with acute head injury, including: I60 — 39 (15 %), I61 — 86 (33 %), I63 — 130 (51 %), I67 — 4 (0,15 %) patients. Center № 1/2 — 159/101 patients. Age — sex composition, level of sedation and pain in the groups did not differ. For examinations in the centers, 2 ICU physicians and 1 neurologist were selected. Reproducibility and interdisciplinary consistency were assessed in pairs with Cronbach’s alpha (α) internal consistency. Statistical analysis was performed using IBM SPSS Statistics Subscription. Conclusions. There are no differences in consistency and reproducibility between FOUR and GSC in stroke patients when used by resuscitators and neurologists in non-specialized ICU. The FOUR scale has maximum reproducibility and wider possibilities for assessing the level of consciousness.