Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: Interrater reliability and relation to outcome

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Purpose: Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score. Patients and Methods: Adult patients with altered mental status due to medical causes were rated by neurology consultants and internal medicine residents on FS and GCS. Interobserver reliability for GCS and FS was assessed using κ score. Relation with outcomes was explored using univariate and multivariate analyses. Main Results: Of the 100 patients (age, 62 ± 17 years), 60 had neurologic conditions; 26, metabolic encephalopathy; 9, infections; and 7, others. Thirty-nine patients died at 3 months κ Scores ranged from 0.71 to 0.85 for GCS and from 0.71 to 0.95 for FS. On multivariate analysis, GCS was predictive of outcome at 3 months; FS was predictive of mortality. Area under the receiver operating characteristic curves suggested equivalent performance of both scoring systems. Conclusions: Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.

Original languageEnglish
JournalJournal of Critical Care
Issue number3
Publication statusPublished - Jun 2013



  • Coma
  • Coma score
  • FOUR score
  • Full Outline of Unresponsiveness
  • Glasgow Coma Scale
  • SOFA score

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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