Comparison of Outcome Prediction Using Full Outline of Unresponsiveness (FOUR) Score and Glasgow Coma Scale (GCS) in Head-Injury Patients

Introduction: Traumatic brain injury (TBI) is a major global health burden, particularly in low- and middle- income countries such as India. Early, reliable neurological assessment is critical for triage and prognostication. The Glasgow Coma Scale (GCS) is long-established but lacks assessment of brainstem reflexes and respiration. The Full Outline of Unresponsiveness (FOUR) score was introduced to overcome these deficiencies. This study compares the predictive performance of the GCS and the FOUR score in patients with head injury.Methods: A prospective observational study was carried out at a tertiary teaching hospital in Puducherry, India (October ۲۰۲۲–November ۲۰۲۴). A sample size of ۱۲۴ was initially taken; after the exclusion of ۲۴ patients,۱۰۰ patients were included. One hundred adults (≥ ۱۸ years) with traumatic head injury selected by simple consecutive sampling were assessed serially with GCS and FOUR scores at admission, ۶, ۱۲, ۲۴, ۴۸, and ۷۲ hours, and at discharge or death. Clinical, radiologic, and outcome data were analyzed using SPSS version ۲۳ (IBM Corp., Armonk, NY, USA); receiver operating characteristic (ROC) curves were used to compare predictive accuracy for mortality, intubation, and ICU requirement. Binary logistic regression identified predictors of in-hospital mortality.Results: A total of ۱۲۴ patients were recruited; after exclusion, ۱۰۰ were included in the study. Mean age ± standard deviation (SD) was ۴۷.۸ ± ۱۷.۶ years; ۸۱% of the patients were male. All injuries were from road traffic accidents. Subdural hematoma (۳۴%) and cerebral contusion (۳۰%) predominated. Mean ± SD was ۸.۹ ± ۲.۶ for admission GCS and ۸.۱ ± ۴.۱ for FOUR score. Mortality was ۱۴%, with ۴۹% good recovery. GCS and FOUR were strongly correlated (r = ۰.۸۳, P < ۰.۰۰۱); FOUR showed marginally higher area under the curve (AUC) for mortality (۰.۸۹ vs. ۰.۸۶).Conclusion: Both GCS and FOUR scores effectively predict outcomes in patients with head injury. The FOUR score offers a modest but clinically meaningful advantage through the inclusion of brainstem and respiratory parameters, improving prognostication in intubated or deeply comatose patients.

کلیدواژه ها:

Full outline of unresponsiveness ، glasgow coma scale ، head injury ، neuro-trauma ، outcome prediction ، Traumatic brain injury