Comparison of the Full Outline of Unresponsiveness score with Glasgow coma scale in comatose patients: A diagnostic study

Abstract

Background: Coma is defined as a significant reduction in the level of consciousness, leading to a state of unarousable unresponsiveness.

Aim: This study aimed to compare the reliability and outcome predictive value of GCS and Full Outline of Unresponsiveness (FOUR) scores in comatose patients.

Methods: This prospective observational study was conducted on 128 comatose patients admitted in the intensive care units (ICUs) of Farshchian and Besat hospitals in Hamadan, Iran. Patients were hospitalized due to neurological disorders and traumatic brain injury. Pearson’s correlation-coefficient was used to evaluate the correlations between FOUR and GCS scores, and Cohen's kappa coefficient was applied to assess the inter-rater agreement. Data analysis was performed in SPSS version 19 at the significance level of P<0.05.

Results: Interobserver agreement of the FOUR score was 0.761, 0.938, and 0.958 on days 1, 3, and 10, respectively. Correlation-coefficient of inter-rater agreement for FOUR score was higher compared to GCS, which was considered favorable for both scales. According to both observers, ROC curve showed a higher predictive value for the FOUR score compared to GCS, while the difference was not significant.

Implications for Practice: According to the results of this study, FOUR score has an excellent reliability in the assessment of consciousness level in comatose patients. Compared to GCS, FOUR has a higher predictive value to measure the level of consciousness in patients admitted in the ICU.