Objective: In this study, we sought to validate the use of FOUR score in the emergency department (ED) using non-neurology staff. We also compared its performance to the Glasgow Coma Scale (GCS) and correlated it to functional outcome at hospital discharge and overall survival.
Patient and method: We prospectively rated 85 patients with initial neurologic symptoms presenting to the ED. Two types of examiners performed the FOUR score: ED physician and ED nurse. Patients were followed through hospital discharge; functional outcome was measured using modified Rankin Score (mRS).
Results: We found that the inter-rater reliability was excellent with the FOUR score (_w _ 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (_w _ 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score.
Conclusions: the neurologic detail incorporated in the FOUR score makes it more useful in management and triage of patients.