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Neuropediatrics 2025; 56(05): 310-319
DOI: 10.1055/a-2627-1974
Original Article

Comparative Analysis of Full Outline of Unresponsive Score and Glasgow Coma Scale Score for Outcomes Prediction in Children with Impaired Consciousness

Bablu Kumar Gaur 
1   Department of Pediatrics, Teerthanker Mahaveer Medical College, and Research Center, TMU, Moradabad, Uttar Pradesh, India
,
Mohamad Habib F. Meman 
1   Department of Pediatrics, Teerthanker Mahaveer Medical College, and Research Center, TMU, Moradabad, Uttar Pradesh, India
,
Shruti Jain 
1   Department of Pediatrics, Teerthanker Mahaveer Medical College, and Research Center, TMU, Moradabad, Uttar Pradesh, India
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Abstract

Objectives

This study aimed to compare two distinct consciousness evaluation scores (the pediatric Glasgow coma scale [GCS] scale and the full outline of unresponsive [FOUR] score) to predict outcomes for children admitted to the pediatric intensive care unit with impaired consciousness.

Methods

Children aged between 2 and 18 years who presented with impaired consciousness were included in this longitudinal study. The lead investigator evaluated the pediatric GCS score and the FOUR score. The first 3 days' score readings of both the scores were taken for analysis. The primary outcome of children was recorded as in-hospital mortality. The secondary outcome was functional outcome measured by the modified Rankin scale.

Results

A total of 78 children presented with impaired consciousness were eligible for statistical analysis. Survivors and nonsurvivors had significantly different FOUR and GCS scores at admission, 24 and 48 hours (p < 0.0001). The predictive accuracy of the FOUR scale at admission was slightly higher than GCS considering that the area under the curve (AUC) for the FOUR score was higher (AUC = 0.850; 95% confidence interval [CI]: 0.735–0.956) than GCS (AUC = 0.834; 95% CI: 0.735–0.934). The projected outcome based on the FOUR score and the actual patient outcomes were statistically significantly correlated (p = 0.021). Results showed that the FOUR scores had higher sensitivity (89%) specificity (84%), and negative predictive value (83%) than the GSC scale.

Conclusion

The FOUR at admission was a better predictor of the outcome as compared with the Glasgow coma scale. More sensitivity of the FOUR scores than GCS makes it an advisable predictive model for children with impaired consciousness.

Keywords

impaired consciousness - GCS score - FOUR score - outcome - children

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the TMU Moradabad Institutional Ethics Committee India (TMU/IEC/2021–22, dated: June 29, 2022).


Clinical Trial Registration

The following in the manuscript clinical trial number is not applicable.


Consent to Participate

Written informed consent was obtained from the parents.


Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.


Declaration of Artificial Intelligence (AI) in Scientific Writing

Artificial Intelligence is not used during paper writing.


Authors' Contributions

All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by M.H.F.M. and S.J. The first draft of the manuscript was written by B.K.G. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 26 February 2025

Accepted: 03 June 2025

Article published online:
18 June 2025

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