We are talking about a full frontal assault on the Glasgow Coma Scale (GCS), the standard clinical way to quantify coma. The details of the new system are still sketchy, but according to the Mayo press release, the following advantages of the FOUR Score are cited:
* Comatose patients remain fully testable even if a tube is inserted to enable breathing, which applies to almost half of all comatose patients
* Brain stem reflexes, indicators of the entire brain’s health emanating from the underside portion of the brain that controls breathing and consciousness, are tested, providing information for immediate intervention and prognosis
* More precise measurements and higher agreement between evaluators than the Glasgow Coma Scale
* Recognition of a locked-in syndrome
* Attention to stages of brain herniation and breathing as indicators of coma depth
* Scores have better correlation with outcomes, e.g., in the comatose patients with lower scores on the FOUR Score and the Glasgow Coma Scale, more patients with low FOUR Score ratings died
Once the scoring system is published, we’ll reproduce it on these pages. For now, it is reported by the Mayo Clinic, that to achieve a coma score, clinicians assign a score of zero to four in each of the four categories, including eye, motor, brain stem and respiratory function.