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Updated: May 12, 2026
Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Comparative Analysis of Full Outline of Unresponsive Score and Glasgow Coma Scale Score for Outcomes Prediction in
Bablu Kumar Gaur1, Mohamad Habib F Meman1, Shruti Jain1
1Department of Pediatrics, Teerthanker Mahaveer Medical College, and Research Center, TMU, Moradabad, Uttar Pradesh, India.
Insights
The Full Outline of Unresponsive (FOUR) score better predicts outcomes in critically ill children with impaired consciousness than the pediatric Glasgow Coma Scale (GCS). The FOUR score demonstrated higher sensitivity and predictive accuracy.
Area of Science:
- Pediatric Critical Care Medicine
- Neurological Assessment
- Outcome Prediction
Background:
- Impaired consciousness in children admitted to the pediatric intensive care unit (PICU) requires accurate assessment for outcome prediction.
- The pediatric Glasgow Coma Scale (GCS) and the Full Outline of Unresponsive (FOUR) score are used to evaluate consciousness.
- Comparing the predictive efficacy of these scores is crucial for optimizing patient management.
Purpose of the Study:
- To compare the predictive accuracy of the pediatric GCS and the FOUR score for in-hospital mortality and functional outcomes in children with impaired consciousness.
- To determine which score is a more sensitive and specific predictor of outcomes in this population.
Main Methods:
- A longitudinal study included 78 children (aged 2-18 years) admitted to the PICU with impaired consciousness.
- Pediatric GCS and FOUR scores were evaluated by a lead investigator within the first 3 days of admission.
- Primary outcome was in-hospital mortality; secondary outcome was functional status using the modified Rankin scale.
Main Results:
- Both FOUR and GCS scores significantly differed between survivors and nonsurvivors at admission, 24, and 48 hours (p < 0.0001).
- The FOUR score showed slightly higher predictive accuracy at admission (AUC = 0.850) compared to GCS (AUC = 0.834).
- FOUR scores demonstrated higher sensitivity (89%), specificity (84%), and negative predictive value (83%) than GCS.
Conclusions:
- The FOUR score is a more effective predictor of outcomes in children with impaired consciousness in the PICU compared to the pediatric GCS.
- The enhanced sensitivity of the FOUR score makes it a recommended predictive model for this patient group.
Abstract:
This study aimed to compare two distinct consciousness evaluation scores (the pediatric Glasgow coma scale [GCS] scale and the full outline of unresponsive [FOUR] score) to predict outcomes for children admitted to the pediatric intensive care unit with impaired consciousness.Children aged between 2 and 18 years who presented with impaired consciousness were included in this longitudinal study. The lead investigator evaluated the pediatric GCS score and the FOUR score. The first 3 days' score readings of both the scores were taken for analysis. The primary outcome of children was recorded as in-hospital mortality. The secondary outcome was functional outcome measured by the modified Rankin scale.A total of 78 children presented with impaired consciousness were eligible for statistical analysis. Survivors and nonsurvivors had significantly different FOUR and GCS scores at admission, 24 and 48 hours (p < 0.0001). The predictive accuracy of the FOUR scale at admission was slightly higher than GCS considering that the area under the curve (AUC) for the FOUR score was higher (AUC = 0.850; 95% confidence interval [CI]: 0.735-0.956) than GCS (AUC = 0.834; 95% CI: 0.735-0.934). The projected outcome based on the FOUR score and the actual patient outcomes were statistically significantly correlated (p = 0.021). Results showed that the FOUR scores had higher sensitivity (89%) specificity (84%), and negative predictive value (83%) than the GSC scale.The FOUR at admission was a better predictor of the outcome as compared with the Glasgow coma scale. More sensitivity of the FOUR scores than GCS makes it an advisable predictive model for children with impaired consciousness.
