{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:37:10Z","timestamp":1792669030746,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2005,9,21]],"date-time":"2005-09-21T00:00:00Z","timestamp":1127260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2005,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The Glasgow Coma Scale (GCS) has been widely adopted. Failure to assess the verbal score in intubated patients and the inability to test brainstem reflexes are shortcomings. We devised a new coma score, the FOUR (Full Outline of UnResponsiveness) score. It consists of four components (eye, motor, brainstem, and respiration), and each component has a maximal score of 4. We prospectively studied the FOUR score in 120 intensive care unit patients and compared it with the GCS score using neuroscience nurses, neurology residents, and neurointensivists. We found that the interrater reliability was excellent with the FOUR score (\u03ba\n                    <jats:sub>w<\/jats:sub>\n                    = 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (\u03ba\n                    <jats:sub>w<\/jats:sub>\n                    = 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score. We conclude that the agreement among raters was good to excellent. The FOUR score provides greater neurological detail than the GCS, recognizes a locked\u2010in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation. The probability of in\u2010hospital mortality was higher for the lowest total FOUR score when compared with the lowest total GCS score. Ann Neurol 2005;58:585\u2013593\n                  <\/jats:p>","DOI":"10.1002\/ana.20611","type":"journal-article","created":{"date-parts":[[2005,9,21]],"date-time":"2005-09-21T19:22:27Z","timestamp":1127330547000},"page":"585-593","source":"Crossref","is-referenced-by-count":824,"title":["Validation of a new coma scale: The FOUR score"],"prefix":"10.1002","volume":"58","author":[{"given":"Eelco F. M.","family":"Wijdicks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Bamlet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boby V.","family":"Maramattom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward M.","family":"Manno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn L.","family":"McClelland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,9,21]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.41.7.603"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91309-I"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199301000-00008"},{"key":"e_1_2_6_6_2","first-page":"161","article-title":"Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years","volume":"75","author":"Balestreri M","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1988.69.5.0699"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1984.60.5.0955"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91840-Q"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.07.429"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410350219"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.64.1.117"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198604103141504"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.19.5.604"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000078817.17321.61"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1997.00550170078017"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.42.12.1163"},{"key":"e_1_2_6_19_2","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1227\/00006123-198505000-00002","article-title":"Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury","volume":"16","author":"Born JD","year":"1985","journal-title":"Neurosurgery"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-198704000-00001"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fana.20611","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.20611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T18:57:44Z","timestamp":1695927464000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.20611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,9,21]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2005,10]]}},"alternative-id":["10.1002\/ana.20611"],"URL":"https:\/\/doi.org\/10.1002\/ana.20611","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,9,21]]}}}