Unlocking Coma Assessments: Exploring Healthcare Professionals' Knowledge and Perception of the Full Outline of...

Background Coma scales play a critical role in assessing the consciousness level of comatose patients, guiding clinical decisions, and predicting patient outcomes. Although the Glasgow Coma Scale (GCS) has been the standard for decades, the Full Outline of UnResponsiveness (FOUR) score offers a more comprehensive assessment. In this study, the awareness, knowledge, and utilization of the FOUR scores among healthcare professionals in Saudi Arabia were explored. Methods This multisite, cross-sectional study was conducted between January and April 2023 and involved physicians specializing in emergency medicine, neurology, neurosurgery, or intensive care. Participants completed a self-administered questionnaire. Results Among 335 participating physicians, only 33% (111) reported having prior knowledge of the FOUR score; 54% (60) of physicians in this group rarely or never used the FOUR score, largely owing to the perception that the GCS suffices (45%, 61), and a lack of awareness among other healthcare professionals (43%, 58). A significant proportion of physicians unfamiliar with the FOUR score have expressed a willingness to adopt alternative scoring systems, and 67% (148) were open to using a system evaluating brainstem reflexes. For respiration and intubation, 65% (143) and 85% (187) of the physicians were open to alternative scoring systems, respectively. There was a significant difference in knowledge between specialties, level of training, and previous neurocritical training (p-values <0.001, 0.032, <0.001, respectively). Conclusion This study revealed a notable gap in knowledge and utilization of the FOUR score in Saudi Arabia, a willingness to explore alternative systems for assessing consciousness, and an interest in comparative studies of various coma scales. Efforts to improve education about the FOUR score among relevant healthcare professionals in Saudi Arabia, in addition to exploring alternative systems, is suggested.