Interobserver Variability of Both Glasgow Coma Scale and Full Outline of Unresponsiveness Scores in Forecasting the Results of Critically Ill Patients with Altered Sensorium

BACKGROUND: Altered mental status (AMS) refers to changes in cognitive function or consciousness, encompassing cognitive, attention, arousal, and consciousness disorders. The Glasgow Coma Scale (GCS) and full outline of unresponsiveness (FOUR) score are tools used to evaluate patients with altered consciousness. Few studies have compared the interobserver reliability of these scales. This study aimed to assess interobserver variability between GCS and FOUR scores in predicting outcomes of critically ill patients with altered sensorium. METHODOLOGY: This hospital-based forecasting experimental study included 200 patients who were admitted to the critical care unit at King Edward Memorial (KEM) Hospital, Pune. Patients were randomly selected and scored once within 24 hours of admission using both GCS and FOUR scores by two independent observers, a critical care resident (CCR) and a critical care consultant (CCC), with a 5-minute interval between assessments. Interrater reliability was measured using kappa values, with outcomes focused on agreement within ±1 score point for both scales. Statistical analysis was conducted using Epi Info. RESULTS: = 0.0423). Interrater agreement showed kappa values for GCS components eye-openings (0.78291), verbal responses (0.64858), and motor responses (0.38867). For FOUR scores, kappa values were eye-openings (0.81014), motor responses (0.77721), brainstem reflexes (0.89801), and respirations (0.91623). CONCLUSION: The study found very good interobserver reliability for GCS eye and verbal components but poor agreement for motor responses due to confusion with localization and abnormal movements. The FOUR score demonstrated good to excellent reliability across all components and provided more detailed neurologic assessments, especially in intubated patients and those with brainstem dysfunction. It is more efficient in predicting outcomes, making it a preferred tool in intensive care units (ICUs). Larger studies are recommended to incorporate the FOUR score as a standard neuromonitoring tool in the intensive care unit.