{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:12:09Z","timestamp":1793293929951,"version":"4.5.0"},"reference-count":17,"publisher":"The Korean Society of Traumatology","issue":"4","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["jtraumainj.org"],"crossmark-restriction":true},"short-container-title":["J Trauma Inj"],"published-print":{"date-parts":[[2025,12,31]]},"abstract":"<jats:p>Purpose: Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, socioeconomic loss, and diminished quality of life among survivors of all injury types. The Glasgow Coma Scale (GCS), though commonly used in the intensive care unit (ICU), has limitations that may be addressed by the Full Outline of Unresponsiveness (FOUR) score. We compared the ability of the FOUR and GCS scores to predict outcomes in patients with TBI.Methods: This prospective observational study included all patients presenting with head injury who survived beyond 24 hours between 2020 and 2022. Basic demographic data, prehospital care details, and neurological findings were collected. TBI severity was assessed using both the GCS and FOUR scores, and outcomes were graded using the Glasgow Outcome Score (GOS).Results: Among 225 patients (mean age, 42.4\u00b119.7 years; male sex, 77.8%) with TBIs, the mortality rate was 4.4%, and 15.1% experienced a poor outcome (GOS \u22642). Receiver operating characteristic curve analysis showed good predictive ability for both the FOUR score (area under the curve [AUC], 0.85) and GCS (AUC, 0.88). FOUR score \u226412 and GCS \u226410 were identified as optimal cutoff values for predicting poor outcomes (P&lt;0.001), with the FOUR score demonstrating sensitivity and specificity of 79.4% and 77.5%, respectively. A FOUR score \u226412 at admission was significantly associated with intubation (odds ratio [OR], 8.2; 95% confidence interval [CI], 4.6\u201314.4; P&lt;0.001), tracheostomy (OR, 21.8; 95% CI. 6.9\u201368.8; P&lt;0.001), and neurological complications, including mental function deficits (OR, 7.5; 95% CI, 3.2\u201317.7; P&lt;0.001), cranial nerve palsy (OR, 4.1; 95% CI, 1.6\u201310.4; P=0.002), and motor deficits (OR, 9.4; 95% CI, 4.6\u201319.2; P&lt;0.001). A strong correlation was observed between the FOUR score and GOS (r=0.7).Conclusions: The FOUR score is a reliable tool for assessing TBI severity and predicting outcomes, with performance comparable to the GCS. An admission FOUR score \u226412 was associated with poor neurological outcomes, increased need for advanced airway management, and long-term disability. By capturing additional neurological parameters beyond the GCS, the FOUR score may offer clinical advantages in ICU settings for early prognostication and management of patients with TBI.<\/jats:p>","DOI":"10.20408\/jti.2025.0125","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T05:59:38Z","timestamp":1767160778000},"page":"327-334","update-policy":"https:\/\/doi.org\/10.20408\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparing the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) for predicting outcomes in traumatic brain injury: a comparative study"],"prefix":"10.20408","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9396-3989","authenticated-orcid":true,"given":"Harsh","family":"Jain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9050-2666","authenticated-orcid":true,"given":"Jishnu N.","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0762-4082","authenticated-orcid":true,"given":"Davuluri Venkata","family":"Shashank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7196-2851","authenticated-orcid":true,"given":"Visvanathan","family":"Krishnaswamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7529-5902","authenticated-orcid":true,"given":"Krishnamurthy","family":"Ganesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"8308","reference":[{"key":"ref1","volume-title":"Traumatic brain injury [updated 2025 Feb 17]. In: StatPearls [Internet]","author":"Ginsburg"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1179\/016164102101199503"},{"key":"ref3","volume-title":"Glasgow Coma Scale [updated 2025 Jun 23]. In: StatPearls [Internet]","author":"Jain","year":"2025"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(14)70120-6"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2000.17.563"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5268"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-77561-w"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.188199"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.5505\/tjtes.2015.83930"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.4065\/84.8.694"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2018.6243"},{"key":"ref12","first-page":"e42","volume-title":"Glasgow Coma Scale and FOUR score in predicting the mortality of trauma patients; a diagnostic accuracy study","author":"Ghelichkhani","year":"2018"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-017-0396-5"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5151.195401"},{"key":"ref15","first-page":"603","volume-title":"Comparison between the ability of Glasgow Coma Scale and Full Outline of Unresponsiveness Score to predict the mortality and discharge rate of pediatric intensive care unit patients","author":"Khajeh","year":"2014"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.5137\/1019-5149.JTN.13536-14.0"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.5505\/tjtes.2012.23169"}],"container-title":["Journal of Trauma and Injury"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/jtraumainj.org\/upload\/pdf\/jti-2025-0125.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/jtraumainj.org\/journal\/view.php?doi=10.20408\/jti.2025.0125","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/jtraumainj.org\/upload\/pdf\/jti-2025-0125.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T05:59:42Z","timestamp":1767160782000},"score":1,"resource":{"primary":{"URL":"http:\/\/jtraumainj.org\/journal\/view.php?doi=10.20408\/jti.2025.0125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12]]}},"URL":"https:\/\/doi.org\/10.20408\/jti.2025.0125","relation":{},"ISSN":["2799-4317","2287-1683"],"issn-type":[{"value":"2799-4317","type":"print"},{"value":"2287-1683","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]},"assertion":[{"value":"2025-06-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}