Accuracy of Glasgow Coma Score and FOUR Score: A Prospective Study in Stroke Patients at Siriraj Hospital
Usapan Surabenjawong MD*, Weeraphon Sonmeethong MD**, Tanyaporn Nakornchai MD*
Affiliation : * Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Emergency Medicine, Klang Hospital, Bangkok
Background : Full Outline of Unresponsiveness Score Coma Scale (FOUR score) is better than Glasgow coma scale (GCS)
for predicting neurological outcome in an intensive care and traumatic patients. However, there is no report in stroke patients
in emergency department (ED).
Objective : Determine the relation between FOUR score and GCS as primary outcome. Secondary outcomes were
prognostication of each score.
Material and Method: This prospective cohort study was conducted in acute stroke patients. Those with history of head
injury were excluded. Patients were evaluated by both scores at ED before definite treatment. All patients were followed-up
at day 3, 7, 30, and 90.
Results : Sixty patients were included. Overall mean FOUR score was 14.05 (SD 4.02) and mean GCS was 12.45 (SD 3.74).
FOUR score and GCS had an excellent correlation with r = 0.821 (p<0.001). FOUR score predicted 3-month mortality
rate better than GCS with area under the curve (AUC) of 1.00 (p<0.001, 95% CI 0.94 to 1.00) while AUC for GCS was
0.99 (p<0.001, 95% CI 0.92 to 0.99). FOUR score was also outstanding in predicting the poor neurological outcome
(modified Rankin Scale 4 to 6 and cerebral performance category 3 to 5) with AUC of 1.00 (p<0.001, 95% CI 1.00 to 1.00).
Conclusion : FOUR score and GCS had an excellent relation. FOUR score is better than GCS for predicting 3-month
mortality and poor neurological outcome in acute stroke patients.
Keywords : Acute stroke, Full outline of unresponsiveness score coma scale, Glasgow Coma Scale
