The Full Outline of UnResponsiveness (FOUR) Score is a coma scale that consists 
of four components (eye and motor response, brainstem reflexes, and 
respiration). It was originally validated among the adult population and 
recently in a pediatric population. To enhance clinical assessment of pediatric 
intensive care unit patients, including those intubated and/or sedated, at our 
children's hospital, we modified the FOUR Score Scale for this population. This 
modified scale would provide many of the same advantages as the original, such 
as interrater reliability, simplicity, and elimination of the verbal component 
that is not compatible with the Glasgow Coma Scale (GCS), creating a more 
valuable neurological assessment tool for the nursing community. Our goal was to 
potentially provide greater information than the formally used GCS when 
assessing critically ill, neurologically impaired patients, including those 
sedated and/or intubated. Experienced pediatric intensive care unit nurses were 
trained as "expert raters." Two different nurses assessed each subject using the 
Pediatric FOUR Score Scale (PFSS), GCS, and Richmond Agitation Sedation Scale at 
three different time points. Data were compared with the Pediatric Cerebral 
Performance Category (PCPC) assessed by another nurse. Our hypothesis was that 
the PFSS and PCPC should highly correlate and the GCS and PCPC should correlate 
lower. Study results show that the PFSS is excellent for interrater reliability 
for trained nurse-rater pairs and prediction of poor outcome and in-hospital 
mortality, under various situations, but there were no statistically significant 
differences between the PFSS and the GCS. However, the PFSS does have the 
potential to provide greater neurological assessment in the intubated and/or 
sedated patient based on the outcomes of our study.