Introduction. The assessment of the level of consciousness in patients with acute brain injury is a mandatory first step of neurological examination. There is a need for clinical scales which allow to assess the level of wakefulness and degree of patient non-responsiveness in 2–3 minutes. The Full Outline of UnResponsiveness (FOUR) scale is an optimal tool for such clinical assessment, which focuses on eye response, motor response, brainstem reflexes, and respiratory pattern. The absence of an officially translated and validated version impedes the use of FOUR scale in Russia, while the use of non-validated clinical scales carries a risk of erroneous diagnosis and reduces the quality and information value of research studies.
Study aim: to develop an official Russian language version of the FOUR scale, taking into account its linguistic and cultural characteristics as part of the validation study.
Materials and methods. The first stage of the validation process was completed, consisting of the linguistic and cultural adaptation of the FOUR scale. Medical professionals (Russian and English native speakers) performed forward and back translations of the original scale. The developed version then underwent review by the Expert Commission, which included a linguist, neurologists, anaesthesiologists and intensive care specialists. The next step was a pilot test of the scale.
Results. The main difficulties in the translated text of the scale were solved during the first meeting of the Expert Commission. Then, taking into account the inclusion and exclusion criteria, a pilot test was performed by assessing 15 patients with the developed version of the FOUR scale. The statistics of this cohort are presented. Investigators had no difficulties in understanding and interpreting the scale instructions during the pilot test. Based on the results, the final version of the scale was adopted. The Russian version of the scale text with instructions and illustrations is presented in this paper.
Conclusion. Translation, linguistic and cultural adaptation of the FOUR scale was conducted at the Research Centre of Neurology (Moscow, Russia). For the first time, the Russian version of the scale is officially presented and recommended for widespread use in clinical and research practice in Russia and other Russianspeaking countries based on the results of pilot testing. The next publication will present the results of the evaluation of psychometric properties (reliability, sensitivity, etc.) of this version of the scale
- Wijdicks E.F., Bamlet W.R., Maramattom B.V. et al. Validation of a new coma scale: The FOUR score. Ann Neurol 2005; 58: 585–593. DOI: 10.1002/ana.20611. PMID: 16178024.
- Kanich W., Brady W.J., Huff J.S. et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med 2002; 20: 613–617. DOI: 10.1053/ajem.2002.35464. PMID: 12442240.
- Masson F., Thicoipe M., Aye P. et al. Epidemiology of severe brain injuries: a prospective population-based study. J Trauma 2001; 51: 481–489. DOI:10.1097/00005373-200109000-00010. PMID: 11535895.
- Masson F., Thicoipe M., Mokni T. et al. Epidemiology of traumatic comas: a pro- spective population-based study. Brain Inj 2003; 17: 279–293. PMID: 12637181.
- Horsting M.W., Franken M.D., Meulenbelt J. et al. The etiology and outcome of non-traumatic coma in critical care: a systematic review. BMC Anesthesiol 2015; 15: 65. DOI: 10.1186/s12871-015-0041-9. PMID: 25924678.
- Teasdale G., Jennett B. Assessment of coma and impaired consciousness. Lancet Neurol 1974; 304: 81–84. DOI: 10.1016/s0140-6736(74)91639-0. PMID: 4136544.
- Teasdale G., Knill-Jones R., Van Der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry 1978; 41:603–610. DOI: 10.1136/jnnp.41.7.603. PMID: 690637.
- Knaus W.A., Draper E.A., Wagner D.P., Zimmerman J.E. A severity of disease classification system. Crit Care Med 1985; 13: 818–829. PMID: 3928249.
- Knaus W.A., Wagner D.P., Draper E.A. et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619-1636. DOI: 10.1378/chest.100.6.1619. PMID: 1959406.
- Le Gall J.R., Lemeshow S.S.F., Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957–2963. DOI: 10.1001/jama.270.24.2957. PMID: 8254858.
- Idrovo L., Fuentes B., Medina J. et al. Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study. Eur Neurol 2010;63: 364–369. DOI: 10.1159/000292498. PMID: 20551672.
- Weiss N., Mutlu G., Essardy F. et al. [The French version of the FOUR score:A new coma score]. Rev Neurol (Paris) 2009; 165: 796–802. DOI: 10.1016/j.neurol.2009.01.045. PMID: 19296997.
- Hickisch A., Holmefur M. Swedish translation and reliability of the Full Outline of Unresponsiveness Score. J Neurosci Nurs 2016; 48: 195–205. DOI:10.1097/JNN.0000000000000205. PMID: 27224684.
- Sivula A., Luoto T., Heinilä J. et al. FOUR score in monitoring the level of consciousness of an intensive care patient: first experience of the use of the Finnish language version. Duodecim 2017; 133: 1081–1091. PMID: 29243901
- Marcati E., Ricci S., Casalena A. et al. Validation of the Italian version of a new coma scale: the FOUR score. Intern Emerg Med 2012; 7: 145–152. DOI:10.1007/s11739-011-0583-x. PMID: 21505790.
- Peng J., Deng Y., Chen F. et al. Validation of the Chinese version of the FOUR score in the assessment of neurosurgical patients with different level of consciousness. BMC Neurol 2015; 15: 254. DOI: 10.1186/s12883-015-0508-9. PMID: 26652248.
- Momenyan S., Mousavi S.M., Dadkhahtehrani T. et al. Predictive validity and inter-rater reliability of the Persian version of Full Outline of Unresponsiveness among unconscious patients with traumatic brain injury in an intensive care unit. Neurocrit Care 2017; 27: 229–236. DOI: 10.1007/s12028-016-0324-0. PMID: 28054286.
- Belkin A.A. [Syndrome effects of intensive therapy — post intensive care syndrome (PICS)]. Vestnik intensivnoy terapii imeni A.I. Saltanova 2018; 2: 12–23. DOI: 10.21320/1818-474X-2018-2-12-23. (In Russ.)
- Piradov M.A., Illarioshkin S.N., Tanashyan M.M. (eds.) [Neurology of the XXI century: diagnostic, therapeutic and research technologies: a guide for doctors in 3 vols]. Мoscow, 2015; 2: 217–270. (In Russ.)
- Mamadaliev A.M., Shakhnovich A.R., Abakumova L.Ia. [Information value of initial clinical signs for the prognosis of outcome in the first 24 hours after craniocerebral injury]. Zh Nevropatol Psikhiatr Im S S Korsakova 1988; 88(5):3–7. PMID: 3046207.
- Beaton D.E., Bombardier C., Guillemin F., Ferraz M.B. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa1976) 2000; 25: 3186–3191. PMID: 11124735.
- Iyer V.N., Mandrekar J.N., Danielson R.D. et al. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc 2009; 84: 694–701.DOI: 10.1016/S0025-6196(11)60519-3. PMID: 19648386.
- Kevric J., Jelinek G.A., Knott J. et al Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. Emerg Med J 2011; 28: 486–490.DOI: 10.1136/emj.2009.085845. PMID: 20943845.
- Almojuela A., Hasen M., Zeiler F.A. The Full Outline of UnResponsiveness (FOUR) Score and its use in outcome prediction: a scoping systematic review of the adult literature. Neurocrit Care 2018; 31: 162–175. DOI: 10.1007/s12028-018-0630-9. PMID: 30411302.
- Fischer M., Rüegg S., Czaplinski A. et al. Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care 2010; 14: R64. DOI:10.1186/cc8963. PMID: 20398274.