Tips To Treasure: The FOUR Score for Neuro Assessments

Neurological assessments are a key component in the care of the neurological patient. It can help the nurse detect the presence of neurological disease or injury and monitor its progression, determine the type of care needed and allow for monitoring of the patient's response to interventions.

The Glasgow Coma Scale (GCS) is the most widely used tool for the evaluation of the level of consciousness. However, there is a new tool that has been developed by a team of researchers led by Wijdicks, at the Mayo Clinic in Rochester, MN. They have created an assessment tool called FOUR (Full Outline of UnResponsiveness) Score, which some facilities are using in place of, or in combination with the GCS.

This new score consists of four components, namely: eye, motor, brainstem and respiration, and each component has a maximum score of 4. The FOUR score had a 20% higher predictive value for patients at risk for higher mortality for poor outcome than the GCS, according to a recent study's findings. The score is easy to learn, has very good inter-rater reliability, and provides a more accurate picture of the patient's status than the GCS.

According to the researchers that developed the score, the FOUR score addresses some of the shortcomings of the GCS, but may be more difficult to administer. The GCS fails to assess the verbal score in patients that are intubated, and isn't able to test brainstem reflexes. In contrast, the FOUR scale does not need a verbal response, thus allowing complete testing in intubated patients, and gives information on brainstem activity and respiratory patterns. This additional information could give the team more insight into the need for intubation. Most importantly, the FOUR scale demonstrated a better discrimination between the good (recovery of independent living) and poor neurological status at 3 months as compared with the GCS.

Want to learn more? Several key websites (listed below) can provide you with more information about this tool.
Innovations Report on Mayo Clinic’s Coma Measurement System located at: http://www.innovations-report.com/html/reports/medical_technology/report-48916.html,

Mayo Clinic Proceedings: Further Validation of the FOUR Score Coma Scale by Intensive Care Nurses located at:  http://www.mayoclinicproceedings.com/content/82/4/435.full.