Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: Interrater reliability and relation to outcome Arunodaya R. Gujjar MBBS, DM a, ⁎ , Poovathru C. Jacob MD a , R. Nandhagopal MBBS, DM a , S.S. Ganguly PhD b , Ammar Obaidy MD a , Abdullah R. Al-Asmi MRCP(C) a a Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman b Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Keywords: Coma; Coma score; Full Outline of Unresponsiveness; FOUR score; Glasgow Coma Scale; SOFA score Abstract Purpose: 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. Patients and 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. Main 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. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Assessment of level of consciousness is an important part of clinical neurologic assessment. Glasgow Coma Scale (GCS) has been the most widely used scale for assessment of sensorium [1]. Earlier studies have shown reasonable ⁎ Corresponding author. Department of Medicine (Neurology), College of Medicine, Sultan Qaboos University, PO Box 35, PC 123, Muscat, Oman. Fax: + 968 24121198. E-mail address: grarunoday@hotmail.com (A.R. Gujjar). 0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2012.06.009 Journal of Critical Care (2013) 28, 316.e1–316.e8