September 28, 2025

Comparison of GCS (Glasgow Coma Scale) Score and FOUR (Full Outline of UnResponsiveness) Score as Predictors of Mortality and Morbidity in Traumatic Brain Injury Patients in an Emergency Department of a Tertiary Care Hospital – A Prospective Observational Study

JPJayakrishnapillai P.V.Sree Chitra Thirunal Institute for Medical Sciences and Technology NNihala BJBrian P. JacobHernia Center

Key Points

FOUR score demonstrates superior predictive accuracy for mortality and morbidity in traumatic brain injury patients.
ROC analysis revealed AUC of 0.9139 for FOUR compared to 0.7840 for GCS, indicating better performance.
FOUR score showed higher sensitivity of 87.5% and specificity of 80.7%, surpassing GCS sensitivity of 68.75%.
Both scores correlate negatively with mortality and poor functional outcomes, emphasizing their prognostic value.

Abstract

Background: Traumatic brain injury remains a major cause of morbidity and mortality globally, with road traffic accidents being the most common cause. Prompt and accurate neurological assessment is crucial for prognosis. Although widely used, the Glasgow Coma Scale (GCS) has limitations, particularly when dealing with intubated patients. The FOUR (Full Outline of UnResponsiveness) score was developed to address these limitations by including brainstem reflexes and respiratory patterns. This study compares the effectiveness of GCS and FOUR scores in predicting mortality and morbidity among TBI (Traumatic Brain Injury) patients. Methods: A hospital-based prospective observational study was conducted in the emergency and neurosurgery departments of Valluvanad Hospital Complex, Ottapalam, from August 2022 to December 2023. Seventy-three patients with TBI, aged above 12 years, were enrolled. GCS and FOUR scores were recorded at presentation. Mortality and morbidity were assessed using the mRS (modified Rankin Scale) at discharge and at 30-day followup. Statistical analyses included ROC curve analysis, Pearson correlation, and comparison of sensitivity, specificity, and predictive values. Results: Among 73 patients, 80.8% were male and 82.2% sustained TBI due to road traffic accidents. The overall mortality rate was 21.9%. Mean GCS and FOUR scores were significantly higher in survivors (GCS: 9.6 ± 2.6, FOUR: 12.1 ± 2.5) compared to non-survivors (GCS: 6.4 ± 2.8, FOUR: 6.8 ± 2.7). ROC analysis revealed an AUC of 0.7840 for GCS and 0.9139 for FOUR in predicting mortality. FOUR score had higher sensitivity (87.5%) and specificity (80.7%) compared to GCS (sensitivity: 68.75%, specificity: 73.68%). There was a statistically significant negative correlation between both scores and mortality, as well as poor functional outcome at 30 days. Conclusion: Both GCS and FOUR scores are effective in predicting mortality and morbidity in TBI patients, but the FOUR score demonstrates superior predictive accuracy, especially in intubated patients or those with impaired verbal communication. It provides a more comprehensive assessment by including brainstem and respiratory functions, making it a more reliable tool in emergency settings

KI fragen

Bookmark

View Full Paper