Comparison of the glasgow coma scale vs four score in assessing conscious level in patients with non-traumatic neurological diseases

Abstract

Glasgow Coma Scale (GCS), most widely used for assessment of conscious level in patients has problems such as inter observer variability, less practical in intubated patients and questionable mid-range predictive value. Recently introduced GCS-P includes pupil examination and a new scale FOUR score considers brainstem reflexes and respiration. Hence, more useful in intubated patients. It is an ongoing Prospective study in a private hospital in Pakistan. Preliminary data collected after obtaining Institutional Review Board (IRB) approval. Admission and discharge GCS, GCS-P and FOUR score for patients >17 years, presenting with non-surgical neurological diseases were documented. Purpose was to see change in scores and correlation with outcome like discharge or death. Descriptive statistics were calculated, and CHI square test was applied to find any significance of difference using power of 0.5%. Total patients were N = 39, mean age of 62 years ±13.7, 51% (20/39) were male, 56% (22/39) had Ischemic stroke. GCS-P on arrival was 13–15 in 61% (24/39), 9–12 in 31% (12/39) and 5–8 in 8% (3/39) vs FOUR score was 13–16 in 92% (36/39), 9–12 in 5% (2/39) and 5–8 in 1% (1/39). GCS-P remained static in 61% (24/39), improved in 7% (13/39) and worsened in 2% (1/39) and one patient died. FOUR score remained static in 92% (35/39), improved in 33% (3/39) and worsened in 2% (1/39). GCS-P and FOUR score are better in assessing the conscious level compared to simple GCS scale. FOUR score has an edge on GCS-P as it excludes speech scores in aphasic patients.