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Ann Card Anaesth. 2019 Apr-Jun;22(2):143-148. doi: 10.4103/aca.ACA_25_18.

Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit.

Author information

School of Nursing and Midwifery, Bojnourd Branch, Islamic Azad University, Bojnurd, Iran.
School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran.



The Glasgow Coma Scale (GCS) is the most commonly used scale, and Full Outline of Unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS in the evaluation of the level of consciousness.


The aim of the current study was to evaluate FOUR score and GCS ability in predicting the outcomes (Survivors, nonsurvivors) in Medical Intensive Care Unit (MICU).

Setting and Design:

This was an observational and prospective study of 300 consecutive patients admitted to the MICU during a 14 months' period.

Materials and Methods:

FOUR score, GCS score, and demographic characteristics of all patients were recorded in the first admission 24 h.

Statistical Analysis Used:

A receiver operator characteristic (ROC) curve, Hosmer-Lemeshow test, and Logistic regression were used in the statistical analysis (95% confidence interval).


Data analysis showed a significant statistical difference in FOUR score and GCS score between survivors and nonsurvivors (P < 0.0001, P < 0.0001; respectively). The discrimination power was good for both FOUR score and GCS (area under ROC curve: 87.3% (standard error [SE]: 2.1%), 82.6% [SE: 2.3%]; respectively). The acceptable calibration was seen just for FOUR score (χ2 = 8.059, P = 0.428).


Both FOUR score and GCS are valuable scales for predicting outcomes in patients are admitted to the MICU; however, the FOUR score showed better discrimination and calibration than GCS, so it is superior to GCS in predicting outcomes in this patients population.


Full outline of unresponsiveness score; Glasgow Coma Scale; Medical Intensive Care Unit; nonsurvivors; survivors

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