COMPARATIVE STUDY OF GLASGOW COMA SCALE AND FULL OUTLINE OF UNRESPONSIVENESS SCALE IN INTERRATER RELIABILITY AND CLINICAL OUTCOMES PREDICTION AMONG NEUROLOGICAL INTENSIVE CARE UNITES PATIENTS

Abstract

Background: consciousness assessment accurately is one of the most critical nursing roles in the intensive care unit. The Glasgow Coma Scale is the standard tool, even though it cannot evaluate verbal responses for intubated patients. The Full Outline of Unresponsiveness scale resolves this by scoring eye, motor, brainstem and respiratory functions, yet it’s uniquely used in Palestine and up to my knowledge no local published study compare the two scales interrater reliability and outcome predication among neurological critical ill intensive care unit patients in Palestine. Objectives: this study compared the predication accuracy and interrater reliability of Glasgow Coma Scale and FOUR for intensive care unit Outcomes, specifically mortality prediction among neurological critically ill adult patients at An Najah National University Hospital. Methods: a prospective cohort observational double blinded design; a convenience sample of 90 adult neurological intensive care unit patients was enrolled from the intensive care units of An-Najah National University Hospital between February 2026 and May 2026. The assigned nurse and the researcher independently scored each patient with both scales upon admission, at 48 hours post admission, and at discharge. Agreement was measured using weighted kappa and Cronbach’s alpha, and predictive performance with receiver operating characteristic curves. Results: the convenience sample were mostly male (71.1%), mean age 45.7 years, predominantly with Subarachnoid Hemorrhage (73.3%). mortality was 8.9%. Glasgow Coma Scale showed substantial interrater agreement (Kappa= 0.784. α=0.992), while FOUR express moderate agreement (Kappa= 0.600. α=0.991). both scales perfectly predicted discharge outcomes 100% sensitivity and specificity with areas under the curve of 0.887 at baseline and 1.00 at 48hr and discharge. None of the scale correlated with length of stay. Conclusion: both scales predicted mortality with comparable accuracy, with predictive performance improving from baseline to discharge. The Glasgow Coma Scale showed slightly higher interrater reliability, while the Full Outline of Unresponsiveness scale may serve as an adjunct for mechanically ventilated or nonverbal patients. Given the single-center design and modest sample size (n=90), larger multicenter studies are required before its adoption can be recommended.