Assessment of neurological status using 4 score and glasgow coma scale in non traumatic brain injury patients

Aims and Objective: To compare 4 score and Glasgow coma scale as prognostic marker for disability in patients with altered neurological status. To assess the interrater reliability of 4 score and Glasgow coma scale. Introduction: Assessing impaired consciousness in the medical and surgical intensive care unit (ICU) is very difficult. To asses the abnormal consciousness ,GCS. Is the major scoring system, but is not designed to capture distinct details of the neurologic examination its reliability in predicting patients outcome is unsatisfactory, especially with regard to the verbal component. It was also found that the reliability of the GCS increases with the experience of its users and that user inexperience is associated with a high rate of errors. A new coma scale, the Full Outline of Unresponsiveness (FOUR) score is based on the minimum of tests necessary to assess a patient with altered consciousnessin the emergency department. it includes much important information that is not assessed by the GCS, like measurement of brainstem reflexes; a broad spectrum of motor responses; and the presence of abnormal breath rhythms and a respiratory drive. Methods: In this prospective study done between January 2019 and may 2019, a total of 40 patients were included. All study patients had both these assessed independently by resident doctor and a nurse at the time of admission and on day 1 of admission. Patients were at the time of discharge to assess quality of life using MODIFIED RANKIN SCORE [MRS]. MRS 3 or less was considered as favorable outcome and scores 4-6 considered as unfavorable outcome. Ability of the maximum Delta [difference between highest and lowest score] and lowest score of GCS and four score to predict unfavorable neurological outcome were compared. Results: A strong agreement using Cronbachs alpha (0.94 and 0.96) was found between doctors and nurses for both GCS and FOUR score at time of admission and on day 1 respectively for all patients. Interrater reliability for FOUR score and GCS was (respectively 0.98and 0.97), Both scores were comparable in predicting neurological outcome. Conclusion: In this study FOUR score and GCS were comparable in their inter rater reliability and prognostic value. Both scores were comparable in assessing the disability in patients with altered neurological status but the neurologic details incorporated in the FOUR score makes it more useful in management and triage of patients.