PENGKAJIAN PASIEN MENGGUNAKAN FOUR SCORE COMA SCALE DI RUANG PERAWATAN INTENSIVE CARE UNIT (ICU)

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Barkah Waladani ◽  
Ning Iswati
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Stem ◽  
Motor Response ◽  
Verbal Response ◽  
Respiratory Pattern ◽  
Average Score ◽  
Coma Scale ◽  
Four Score ◽  
Brain Stem Reflex

Patients with poor conditions or decreased awareness need appropriate assessment to determine the management to be given. Awareness assessments can be done using FOUR (Full Outline of Response) scores with a range of scores from 0 to 16, consisting of eye response, motor response, brain stem reflex and respiration pattern FOUR score is used by nurses in the intensive care unit (Intensive Care Unit). ICU). The method of this study was descriptive analytical and numerator testing between oberserver prospectively to evaluate FOUR score to 100 patients in the ICU from October to December 2017. This study compared FOUR score with the GCS (Glasgow Coma Scale). Each patient was assessed using FOUR score and GCS by nurses. The average score is calculated based on the results obtained in both scoring. The results showed that the numerator test for FOUR score was very good (eye response 0.94, motor response 0.95, brain stem reflex 0.96 and respiratory pattern 1.00) and for GCS it was also very good (eye response 0.94, motoric response 0.95, verbal response 0.97). In predictive terms, GCS is better than FOUR score (characteristic curve value 0.01 difference; GCS 0.76 and FOUR score 0.75). The mortality rate of patients with FOUR scale was the lowest 0 (87%) compared with the lowest GCS score of 3 (70%). FOUR score has an excellent interpersonal and intensivisional level. In contrast to GCS, all components in FOUR score can be assessed even when the patient is installed intubation.

scholarly journals Validity of the FOUR Score Coma Scale in the Medical Intensive Care Unit

2009 ◽  
Vol 84 (8) ◽  
pp. 694-701 ◽  
Author(s):  
Vivek N. Iyer ◽  
Jayawant N. Mandrekar ◽  
Richard D. Danielson ◽  
Alexander Y. Zubkov ◽  
Jennifer L. Elmer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Coma Scale ◽  
Four Score ◽  
Medical Intensive Care

scholarly journals Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients

2020 ◽  
Vol 40 (4) ◽  
pp. e18-e26
Author(s):  
Ayda Kebapçı ◽  
Gül Dikeç ◽  
Serpil Topçu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glasgow Coma Scale ◽  
Interobserver Reliability ◽  
Verbal Response ◽  
Coma Scale ◽  
Significant Agreement ◽  
Scale Scores ◽  
Sum Scores ◽  
Intensive Care Unit Nurses

Background Intensive care units frequently use the Glasgow Coma Scale to objectively assess patients’ levels of consciousness. Interobserver reliability of Glasgow Coma Scale scores is critical in determining the degree of impairment. Objective To evaluate interobserver reliability of intensive care unit patients’ Glasgow Coma Scale scores. Methods This prospective observational study evaluated Glasgow Coma Scale scoring agreement among 21 intensive care unit nurses and 2 independent researchers who assessed 202 patients with neurosurgical or neurological diseases. Each assessment was completed independently and within 1 minute. Participants had no knowledge of the others’ assessments. Results Agreement between Glasgow Coma Scale component and sum scores recorded by the 2 researchers ranged from 89.5% to 95.9% (P = .001). Significant agreement among nurses and the 2 researchers was found for eye response (73.8%), motor response (75.0%), verbal response (68.1%), and sum scores (62.4%) (all P = .001). Significant agreement among nurses and the 2 researchers (55.2%) was also found for sum scores of patients with sum scores of 10 or less (P = .03). Conclusions Although the study showed near-perfect agreement between the 2 researchers’ Glasgow Coma Scale scores, agreement among nurses and the 2 researchers was moderate (not near perfect) for subcomponent and sum scores. Accurate Glasgow Coma Scale evaluation requires that intensive care unit nurses have adequate knowledge and skills. Educational strategies such as simulations or orientation practice with a preceptor nurse can help develop such skills.

Assessing the Comatose Patient in the Intensive Care Unit

1991 ◽  
Vol 2 (4) ◽  
pp. 613-622 ◽  
Author(s):  
Christina Stewart-Amidei
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Motor Response ◽  
The United States ◽  
Complex Phenomenon ◽  
Comatose Patient ◽  
Reticular Activating System ◽  
Predicting Outcome ◽  
Pupillary Size

Consciousness is a complex phenomenon comprising arousal and awareness. These functions are mediated by the reticular activating system that begins in the brainstem and projects to higher cortical structures. Abnormalities directly or indirectly affecting this system may produce coma. Detailed neurologic assessment consists of evaluation of history, skeletal motor response, pupillary size and reactivity, eye movement, and respiratory patterns. Information obtained may be useful in localizing the contributory lesion, predicting outcome, and determining brain death. Several scales have been used to quantify coma, each with limitations. In the United States, the most widely used scale is the Glasgow Coma Scale

Determination of Imminent Brain Death Using the Full Outline of Unresponsiveness Score and the Glasgow Coma Scale: A Prospective, Multicenter, Pilot Feasibility Study

2017 ◽  
Vol 35 (2) ◽  
pp. 203-207 ◽  
Author(s):  
Sergio Zappa ◽  
Nazzareno Fagoni ◽  
Michele Bertoni ◽  
Claudio Selleri ◽  
Monica Aida Venturini ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Death ◽  
Brain Stem ◽  
Deep Coma ◽  
Coma Scale ◽  
Four Score ◽  
Gcs Score ◽  
Brain Stem Reflexes ◽  
Pilot Feasibility Study

Purpose: To evaluate the accuracy of the imminent brain death (IBD) diagnosis in predicting brain death (BD) by daily assessment of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) with the assessment of brain stem reflexes. Materials and Methods: Prospective multicenter pilot study carried out in 5 adult Italian intensive care units (ICUs). Imminent brain death was established when the FOUR score was 0 (IBD-FOUR) or the GCS score was 3 and at least 3 among pupillary light, corneal, pharyngeal, carinal, oculovestibular, and trigeminal reflexes were absent (IBD-GCS). Results: A total of 219 neurologic evaluations were performed in 40 patients with deep coma at ICU admission (median GCS 3). Twenty-six had a diagnosis of IBD-FOUR, 27 of IBD-GCS, 14 were declared BD, and 9 were organ donors. The mean interval between IBD diagnosis and BD was 1.7 days (standard deviation [SD] 2.0 days) using IBD-FOUR and 2.0 days (SD 1.96 days) using IBD-GCS. Both FOUR and GCS had 100% sensitivity and low specificity (FOUR: 53.8%; GCS: 50.0%) in predicting BD. Conclusions: Daily IBD evaluation in the ICU is feasible using FOUR and GCS with the assessment of brain stem reflexes. Both scales had 100% sensitivity in predicting IBD, but FOUR may be preferable since it incorporates the pupillary, corneal, and cough reflexes and spontaneous breathing that are easily assessed in the ICU.

Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit

1993 ◽  
Vol 21 (10) ◽  
pp. 1459-1465 ◽  
Author(s):  
PAULO G. BASTOS ◽  
XIAOLU SUN ◽  
DOUGLAS P. WAGNER ◽  
ALBERT W. WU ◽  
WILLIAM A. KNAUS
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale

APPROPRIATE USE OF THE GLASGOW COMA SCALE IN THE INTENSIVE CARE UNIT: VERBAL SCORES IN INTUBATED PATIENTS

1995 ◽  
Vol 23 (Supplement) ◽  
pp. A228
Author(s):  
Christopher Lentz ◽  
Samir Fakhry ◽  
John Hunt ◽  
Robert Rutledge
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glasgow Coma Scale ◽  
Appropriate Use ◽  
Coma Scale
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