Comparison of Full Outline of Unresponsiveness (FOUR) and Glasgow Coma Scale (GCS) in Determining Outcome among Patients in Critical Care Units – A Prospective Study

Abstract

Accurate assessment and monitoring of level of consciousness is fundamental for prompt management and recognising warning signs of deterioration in the patient. The Glasgow coma scale (GCS), a widely used tool was compared with full outline of unresponsiveness (FOUR) score as an alternate tool for assessment and prognostication of the outcome. The purpose of this study aimed to compare and evaluate the accuracy between GCS and FOUR score (FS) tool in the neurological assessment and predicting the functional outcome. Materials and Methods: For this observational study, 131 patients were recruited from two major teaching hospitals in Middle Eastern countries. Data was collected on admission from emergency department and reassessed on day two & four. Patient was followed on discharge and outcome evaluated using the Glasgow outcome scale (GOS). Results: The mean age was 56.39±17.29 (18- 87years) with 83(63.4%) male patients. 93 (71%) patients admitted with neurological problems. In terms of predicting the outcome using the GOS, the area under the ROC curve was 92% (CI- 95%, 0.870-0.975) for FS and 74.73 % (CI-95%, 0.825-0.951) for GCS. The sensitivity and specificity for FS on admission (0.976 & 0.543), day two (0.971 & 0.495) & day four (0.971 & 0.340) and for GCS is (0.918 & 0.370) (0.941 & 0.433) (0.971 & 0.330). Conclusions: The FS tool is precise in predicting power of mortality and is an ideal complementary or substitute tool for GCS.