{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:40:29Z","timestamp":1787071229794,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Full outline of unresponsiveness (FOUR) score has advantages over Glasgow Coma Scale (GCS); as it can be used in intubated patients and provides greater neurological details. It has been studied mainly in the trauma and neuroscience setting. Our primary objective was to compare the FOUR versus GCS score as predictors of mortality at 30 days and poor functional outcome at 3 months among nontrauma patients in the emergency department (ED).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study was conducted on adult patients presenting with altered mental status (duration &lt;7 days) in the ED (March 2019\u2013November 2020). Data collection included demographic and clinical features, the GCS and FOUR scores, the feasibility of acquiring and interpreting FOUR on a Likert scale, duration of hospital stay, 30-day mortality, and functional outcome at 3 months on the modified Rankin Scale. Trained emergency medicine residents managing the patient collected the data. The area under receiver\u2019s operating characteristics curve (AUROC) was used to compare the accuracy of the GCS and FOUR scores in predicting outcomes. The FOUR score equivalent of GCS cutoffs for categorizing neurological impairment (mild, moderate, and severe) was also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Two hundred and ninety-one patients were included, with a mean age of 50.3 years and 67.4% males. Most patients (40.2%) had altered mental status for 1\u20133 days and hepatic encephalopathy was the most common ED diagnosis. The mortality at 30 days was 66.7% (194 of 291), and 88% (256 of 291) of patients had poor functional outcomes at 3 months. The AUROCs for predicting 30-day mortality were similar for both the scores (GCS: 0.70, FOUR: 0.71, and the\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value for difference: 0.9). Similarly, the AUROCs for predicting 3-month poor functional outcome were 0.683 and 0.669 using GCS and FOUR, respectively, with a nonsignificant difference (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.82). The FOUR score strata of 14\u201316, 11\u201313, and 0\u201310 were found to be equivalent to the GCS scores of 13\u201315 (mild), 9\u201312 (moderate), and 3\u20138 (severe). The feasibility of acquiring and interpreting GCS and FOUR scores on the Likert scale was found to be \u201ceasy.\u201d\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The FOUR score is similar to GCS in predicting mortality at 30 days and poor neurological outcomes at 3 months among nontrauma patients of ED. Moreover, it was found that the FOUR score is \u201ceasy\u201d to assess and interpret by the emergency residents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jets.jets_76_23","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T07:48:56Z","timestamp":1719388136000},"page":"102-106","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Full Outline of Unresponsiveness Score versus Glasgow Coma Scale in Predicting Clinical Outcomes in Altered Mental Status"],"prefix":"10.4103","volume":"17","author":[{"given":"Savan","family":"Pandey","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankit Kumar","family":"Sahu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meera","family":"Ekka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Modi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayer","family":"Jamshed","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Bhoi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"R1-20260506","first-page":"548","article-title":"The Glasgow coma scale: Time for change","volume":"21","author":"Segatore","year":"1992","journal-title":"Heart Lung"},{"key":"R2-20260506","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/ana.20611","article-title":"Validation of a new coma scale: The FOUR score","volume":"58","author":"Wijdicks","year":"2005","journal-title":"Ann Neurol"},{"key":"R3-20260506","doi-asserted-by":"crossref","first-page":"R64","DOI":"10.1186\/cc8963","article-title":"Inter-rater reliability of the full outline of unresponsiveness score and the Glasgow coma scale in critically ill patients: A prospective observational study","volume":"14","author":"Fischer","year":"2010","journal-title":"Crit Care"},{"key":"R4-20260506","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/MEJ.0b013e32830346ab","article-title":"Comparison of the full outline of unresponsiveness score coma scale and the Glasgow coma scale in an emergency setting population","volume":"16","author":"Eken","year":"2009","journal-title":"Eur J Emerg Med"},{"key":"R5-20260506","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s12028-008-9145-0","article-title":"Validation of a new coma scale, the FOUR score, in the emergency department","volume":"10","author":"Stead","year":"2009","journal-title":"Neurocrit Care"},{"key":"R6-20260506","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/emj.2009.085845","article-title":"Validation of the full outline of unresponsiveness (FOUR) scale for conscious state in the emergency department: Comparison against the Glasgow coma scale","volume":"28","author":"Kevric","year":"2011","journal-title":"Emerg Med J"},{"key":"R7-20260506","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"R8-20260506","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1007\/s12028-019-00806-4","article-title":"A comparison of the full outline of unresponsiveness (FOUR) and Glasgow coma scale (GCS) scores in predicting mortality among patients with reduced level of consciousness in Uganda","volume":"32","author":"Abdallah","year":"2020","journal-title":"Neurocrit Care"},{"key":"R9-20260506","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/CCM.0000000000000707","article-title":"Comparison of the full outline of unresponsiveness score and the Glasgow coma scale in predicting mortality in critically ill patients*","volume":"43","author":"Wijdicks","year":"2015","journal-title":"Crit Care Med"},{"key":"R10-20260506","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4103\/aca.ACA_25_18","article-title":"Comparison of full outline of unresponsiveness score and Glasgow coma scale in medical intensive care unit","volume":"22","author":"Ramazani","year":"2019","journal-title":"Ann Card Anaesth"}],"container-title":["Journal of Emergencies, Trauma, and Shock"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_76_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:43:25Z","timestamp":1787067805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_76_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/jets.jets_76_23","relation":{},"ISSN":["0974-2700","0974-519X"],"issn-type":[{"value":"0974-2700","type":"print"},{"value":"0974-519X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4]]},"assertion":[{"value":"2023-07-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}