A Comparison of Full Outline of UnResponsiveness Score with Glasgow Coma Scale Score in Predicting Outcomes among Patients with Altered Mental Status Admitted to the Critical Care Unit

AIM: Comparison of the Full Outline of UnResponsiveness (FOUR) score with the Glasgow Coma Scale (GCS) score to find the better scoring system for predicting outcomes among altered sensorium patients in the critical care unit. MATERIALS AND METHODS: This is a prospective observational study. It included 100 patients of altered sensorium, whose GCS and FOUR scores were calculated at admission and followed up till death or discharge to note the outcome. Individual demographics and diagnosis were recorded, and the results were analyzed statistically. RESULTS: The correlation between the two scores was excellent, with the Spearman's correlation coefficient of 0.88. Discrimination ability of the two scoring systems, as assessed by the area under the receiver operating characteristic curve, was 0.778 for GCS score and 0.883 for FOUR score (p <0.001). When area under the curve (AUC) was calculated exclusively in stroke cases, it was 0.836 for GCS score and 0.944 for FOUR score. Among nonstroke cases, the AUC was 0.756 and 0.859, respectively. However, the 95% confidence limits were overlapping among the corresponding scores. CONCLUSION: The above study concludes that there is a good correlation between GCS and FOUR scores in predicting outcomes. Superiority of FOUR score could not be established statistically in view of overlapping confidence limits. However, it performed at par with GCS in prognosticating mortality among patients with altered sensorium. CLINICAL SIGNIFICANCE: In critically ill patients with altered sensorium, explaining the prognosis to the attendants is a challenge for the physician. The commonly used GCS score has several shortcomings, especially in intubated patients. Use of the FOUR score can overcome these shortcomings and help in prognostication of these patients. In view of its good correlation with GCS score and equal efficacy in predicting outcomes in varied etiologies, it can be used as a good alternative to the GCS score. HOW TO CITE THIS ARTICLE: Javvaji PK, Nagatham P, Venkata RR, Puttam H, John SK, Karavalla H, et al. A Comparison of Full Outline of UnResponsiveness Score with Glasgow Coma Scale Score in Predicting Outcomes among Patients with Altered Mental Status Admitted to the Critical Care Unit. Indian J Crit Care Med 2022;26(2):210–215.