BACKGROUND

Assessment of cerebral damage severity and prognosis is essential in choosing the treatment strategy for acute cerebral insufficiency. Correct analysis of injury and prediction of outcomes are obviously important for choosing the adequate treatment strategy. However, there is still no accurate objective assessment tool. Developed in 1974, the Glasgow Coma Scale (GCS) has become an integral part of clinical practice worldwide. Although GCS is a routine method, it has some significant drawbacks. The new Full Outline of UnResponsiveness (FOUR) coma scale is based on the minimum number of necessary tests to analyze severity of cerebral damage and prognosis. The FOUR scale is actively used abroad and In Russia. There is a Russian version of this scale approved and accepted by the FAR.

OBJECTIVE

To increase the effectiveness of clinical monitoring of patients with ACI by improving the discriminatory ability of the FOUR scale; to study sensitivity and specificity of this scale in chronic disorders of consciousness.

MATERIAL AND METHODS

A multiple-center non-randomized study included 2000 adults with ACI who were followed-up for 14 days in 10 ICUs. To test the hypothesis and study design, a single-center non-randomized cohort study was initiated using a continuous sampling method (“FOURACI” NCT06043167 ClinicalTrials.gov).

RESULTS

Spread of the FOUR scale and high need for effective clinical monitoring of patients with ACI inspired a two-stage observational prospective study in 2023. The first results when testing the hypothesis and study design confirm the advantages of the FOUR scale.

CONCLUSION

The first results confirm high specificity of the FOUR scale for clinical assessment of impaired consciousness in intensive care patients with acute cerebral insufficiency.