title: Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: interrater reliability and relation to outcome.
abstract: OBJECTIVE
  Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score.
  
  
  METHODS
  Adult patients with altered mental status due to medical causes were rated by neurology consultants and internal medicine residents on FS and GCS. Interobserver reliability for GCS and FS was assessed using κ score. Relation with outcomes was explored using univariate and multivariate analyses.
  
  
  RESULTS
  Of the 100 patients (age, 62 ± 17 years), 60 had neurologic conditions; 26, metabolic encephalopathy; 9, infections; and 7, others. Thirty-nine patients died at 3 months. κ Scores ranged from 0.71 to 0.85 for GCS and from 0.71 to 0.95 for FS. On multivariate analysis, GCS was predictive of outcome at 3 months; FS was predictive of mortality. Area under the receiver operating characteristic curves suggested equivalent performance of both scoring systems.
  
  
  CONCLUSIONS
  Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
authors.affiliation: Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. grarunoday@hotmail.com
authors.forename: Arunodaya R
authors.initials: AR
authors.lastname: Gujjar
authors.forename: Poovathru C
authors.initials: PC
authors.lastname: Jacob
authors.forename: R
authors.initials: R
authors.lastname: Nandhagopal
authors.forename: S S
authors.initials: SS
authors.lastname: Ganguly
authors.forename: Ammar
authors.initials: A
authors.lastname: Obaidy
authors.forename: Abdullah R
authors.initials: AR
authors.lastname: Al-Asmi
mesh_terms: D003128:Coma / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results