Validation of the FOUR Coma Scale in Russia. — FOUR-RUS  

Stroke Clinical Trial

Official title: Validation of the FOUR Coma Scale in Russia. - a Prospective Observational Multi-center Cohort Study

Status Completed

Clinical Trial Summary

The purpose of this study is to examine the validity of the Russian version of the FOUR Full Outline of UnResponsiveness (hereafter FOUR) scale in adult ICU patients with an acute cerebral insufficiency clinic (hereinafter referred to as OTSN). Compare the accuracy and predictive significance of FOUR when used by an ICU specialist, a neurologist, nursing staff, during bedside and telemedicine Examinations.

Clinical Trial Description

The key step in choosing a strategy for treating acute cerebral insufficiency is the assessment of the severity of cerebral damage and prognosis. The importance of correcting the severity of damage and prognosis for the choice of treatment strategy is beyond doubt.

At the same time, the complexity of objective evaluation is preserved throughout the world, after more than 40 years, has become an integral part of clinical practice worldwide. The findings obtained using GCS showed a strong relationship with those obtained using other indicators of severity and outcome. Although the scale of Glasgow coma is considered routine method, it has a number of significant drawbacks.

First, the verbal response of GCS tests often becomes inadequate in psychomotor-excited patients. On the contrary, in many patients with depressed consciousness, the verbal response is insufficient. Moreover, the GSC verbal response assessment cannot be applied to critical patients or those who have undergone intubation.

Secondly, and most importantly, GSC does not assess brain stem reflexes, eye movements, or complex motor responses in patients with altered consciousness. In addition, the GCS score is numerically skewed toward the motor response (the maximum number of points given for the motor response). These deficiencies previously caused repeated attempts to improve GCS: reaction level scale (RLS85), comprehensive consciousness level Scale (CLOCS), clinical neurological assessment (CNA) , Coma Recovery Scale (CRS), Glasgow-Liege Scale (GLS), Innsbruck Coma Scale (ICS), 15 and 60-second test (SST). Similar scans, tests are very long and laborious. None of these subsequently gained enough weight to replace GCS.

Third, despite the fact that GSC is regularly used in therapeutic and surgical intensive care units and resuscitation units, as well as the fact that it is usually used in conjunction with the APACHE system assessment, reliability in predicting outcomes in patients is unsatisfactory. Fourthly, Rowley and Fielding found that the reliability of the GCS score increases with the experience of its users and that user inexperience is associated with a high error rate.

The new coma scale, Full Outline of UnResponsiveness (FOUR), is based on the minimum number of tests needed to analyze the severity of cerebral damage and prognosis. Universal and suitable, including for patients with altered consciousness. The FOUR scale has four categories studied. In contrast to GCS, the number of components and the maximum rating in each category are four (E4, M4, B4, R4). This is significantly easier than in GCS with different points for each category. The FOUR scale is suitable for assessing a patient with a locked person syndrome, as well as in the presence of a vegetative state. Conditions when the eyes can open spontaneously, but cannot follow the pointer. The motor or motor component is recorded primarily on the limb. Response options include the presence of status epilepticus, myoclonus. Also, the motor response combines decorticative regimen and generalized myoclinic status. Hand position tests (thumb up, fist, and peace sign) are reliable for assessing wakefulness. Three reflexes assessing brain stem depression, testing the functions of the midbrain, pons and medulla oblongata, are used in various combinations. The clinical sign of acute dysfunction of the third pair of FMN (unilateral pupil dilation), pupillary and oculomotor reactions is assessed. Separately, the functioning of the respiratory center, as the lower part of the brain stem, is considered. In intubated patients, the presence of independent attempts between cycles of mechanical ventilation is assessed. The value of 0 in all responses is the basis for considering the diagnosis of brain death. The FOUR evaluation of the lung is reproducible and takes several minutes.

The use of the FOUR scale in an intensive care unit and intensive care unit was validated in 2009 at the Mayo Clinic - one of the largest private non-profit medical and research centers in the world. A team led by F. M. Wijdicks. To determine whether the values of the FOUR scale are equally suitable for use by both doctors and nurses without neuro-resuscitational experience, the values of the FOUR scale were prospectively tested when used by the staff of the intensive care unit. The indicators obtained by experienced and inexperienced paramedical staff of OriIT and doctors were compared.

The FOUR scale is actively used both abroad and in Russia. At the same time, at the moment, there is no Russian version of the FOUR scale approved and accepted by the PAR.

The purpose of this study is to examine the validity of the Russian version of the FOUR Full Outline of UnResponsiveness scale. (further FOUR) A multicenter prospective non-randomized cohort study is planned. The research centers are located on the basis of the intensive care unit and intensive care, the Neurological department for patients with acute endocrine tumors of the Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg, the Department of Neuro-Reanimation MAU GKB No. 40, Yekaterinburg, the intensive care unit and intensive care Regional Hospital No. 1 named after. Ochapovskogo Krasnodar. The task is to compare the accuracy and prognostic significance of the FOUR scale when used by an ICU specialist, a neurologist, nursing staff, during bedside and telemedicine examinations. For the evaluation, it is planned to examine in 200 visits 200 adult ICU patients (including the ICU of the Department of Neurology) with the clinic of the leading syndrome of acute cerebral insufficiency, as a manifestation of the underlying disease of the vascular pathology of the brain or cranial trauma. The basis for the comparison of the severity of cerebral damage and prognosis is to use the values of the FOUR and GSC scales, the component of organ damage - the SOFA scale. The data obtained from a bedside and telemedicine examination, randomly selected by a couple of employees (reanimatologist / neurologist, nurse / neurologist, neuroreanimatologist / neurologist, neuroreanimatologist / reanimatologist.) Will be compared against the background of the assessment of vital functions, depth and quality of sedation, analgesia. The basis of statistical analysis is proposed to take pairwise weighted For record keeping, an individual registration card ;

Related Conditions & MeSH terms

• Brain Injuries
• Brain Injuries, Traumatic
• Hemorrhage
• Stroke
• Subarachnoid Hemorrhage
• Traumatic Brain Injury

• NCT number: NCT04018989
• Study type: Observational
• Source: Russian Federation of Anesthesiologists and Reanimatologists
• Status: Completed
• Start date: July 20, 2019
• Completion date: December 10, 2019