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See detailComparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population.
Bruno, Marie-Aurélie ULg; LEDOUX, Didier ULg; LAMBERMONT, Bernard ULg et al

in Neurocritical Care (2011), 15(3), 447-53

BACKGROUND: The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liege Scale (GLS) in the evaluation of consciousness in severely brain ... [more ▼]

BACKGROUND: The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liege Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state. METHODS: FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) brain-damaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Inter-rater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136). RESULTS: GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit. CONCLUSIONS: The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales. [less ▲]

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See detailCognitive Event-Related Potentials in Comatose and Post-Comatose States
Vanhaudenhuyse, Audrey ULg; Laureys, Steven ULg; Perrin, F.

in Neurocritical Care (2008), 8(2), 262-70

We review the interest of cognitive event-related potentials (ERPs) in comatose, vegetative, or minimally conscious patients. Auditory cognitive ERPs are useful to investigate residual cognitive functions ... [more ▼]

We review the interest of cognitive event-related potentials (ERPs) in comatose, vegetative, or minimally conscious patients. Auditory cognitive ERPs are useful to investigate residual cognitive functions, such as echoic memory (MMN), acoustical and semantic discrimination (P300), and incongruent language detection (N400). While early ERPs (such as the absence of cortical responses on somatosensory-evoked potentials) predict bad outcome, cognitive ERPs (MMN and P300) are indicative of recovery of consciousness. In coma-survivors, cognitive potentials are more frequently obtained when using stimuli that are more ecologic or have an emotional content (such as the patient's own name) than when using classical sine tones. [less ▲]

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