Comparison of the Full Outline of Unresponsiveness Score Coma Scale and the Glasgow Coma Scale in an emergency setting population

Abstract

Background 

The Glasgow Coma Scale (GCS) is the most widely used tool for the evaluation of the level of consciousness. The Full Outline of Unresponsiveness (FOUR) Score is a new coma Scale that was developed considering the limitations of the GCS, and has been found to be useful in an intensive care setting. We aimed to compare FOUR Score and GCS in the emergency setting.

Methods 

All patients older than 17 years who presented with an altered level of consciousness, after any trauma to the head or with neurological complaints were included in this study. Three-month mortality, in-hospital mortality, and poor outcome using a Modified Rankin Scale (MRS) of 3–6 points were used as the primary outcome measures.

Results 

A total of 185 patients were included in the study. Area under the curve (AUC) values in predicting 3-month mortality for GCS was 0.726 [P=0.0001 and 95% confidence interval (CI): 0.656–0.789] and 0.776 (P=0.0001 and 95% CI: 0.709–834) for FOUR Score. AUC in predicting hospital mortality for GCS was 0.735 (P=0.0001 and 95% CI: 0.655–0.797) and 0.788 (P=0.0001 and 95% CI: 0.722–0.844) for FOUR Score. AUC in predicting poor outcome (Modified Rankin Scale: 3–6) was 0.720 (P=0.001 and 95% CI: 0.650–784) for GCS and 0.751 (P=0.0001 and 95% CI: 0.682–0.812) for FOUR Score.

Conclusion 

The new coma Scale, FOUR Score, is not superior to the GCS. However, the combination of the eye and motor components of FOUR Score is a valuable tool that can be used instead of either the FOUR Score or GCS.