Comparison of the Accuracy of the GCS and FOUR Scores in Predicting Mortality of Patients with Traumatic Brain Injury (TBI) Admitted to the Emergency Department: A Prospective Study in Khorramabad, Iran

Background: Traumatic brain injury (TBI) is a significant public health challenge worldwide; thus, managing these patients based on their condition and level of consciousness is crucial. The Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) scores are two measures for assessing the level of consciousness in these patients. Objectives: The present study aimed to compare the GCS and FOUR scores in predicting outcomes for patients with TBI. Methods: This study is a prospective observational study involving 98 patients with TBI who presented to the Emergency Department of Shohada-ye Ashayer Hospital in autumn, 2023. Patient information and the GCS and FOUR scores were recorded at the earliest opportunity following admission. Chi-square and Fisher’s exact tests were used to examine the frequency of the data, and an independent t-test was employed to compare the mean scores of GCS and FOUR. The ROC curve was used to assess the positive and negative predictive values (PPV and NPV), sensitivity, and specificity of both measures for predicting patient outcomes. Results: Among the 98 patients studied, 75 (76.5%) were male and 23 (23.5%) were female, with a mean age of 43.5 ± 19.5 years. Of this population, 18 patients (18.36%) died, and 80 patients (81.64%) survived. The area under the ROC curve (AUC) for the GCS indicated a diagnostic power of 0.972, with a sensitivity of 95% and a specificity of 88.9% at a cutoff of 7. For the FOUR score, the AUC indicated a diagnostic power of 0.991, with a sensitivity of 98.8% and a specificity of 88.9% at a cutoff of 6. The independent t-test showed a significant difference in the mean scores obtained on the GCS and FOUR scores between those who died and those who survived (P < 0.001). Conclusions: This study demonstrated that both the GCS and FOUR scores performed well and similarly in assessing patients with TBI and predicting their outcomes, indicating that either can be utilized effectively in patients with TBI.