Glasgow Coma Scale and Full Outline of Unresponsiveness Score Instruments to Determine Patient Outcome: A Systematic Review


  • Ika Silvitasari School of Health Sciences Aisyiyah, Surakarta, Central Java
  • Wahyuni Wahyuni School of Health Sciences Aisyiyah, Surakarta, Central Java


Background: Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness Sco­re (FOUR score) are instruments to determine the level of patient consciousness. The­se instruments require good sensitivity and specificity, so that they can be used quickly and easily. This study aimed to determine the validity and reliability of GCS and FOUR sco­re instruments in determining adult patient outcome.

Subjects and Method: This study was a systematic review study. The search for the articles involved the client population treated in the ICU, Emergency Installation and neu­rology room, patients who did not receive sedation or neuro blockers, were ob­ser­ved by health workers. The outcomes were in the form of death of patients in the hos­pi­tal, mRS, Glasgow outcome score, and APACHE II. This study were carried out using EBSCO, Sciencedirect, Pubmed, and Google Scholar, restricted articles from 2007-2017, and observational study. The number of articles that was in accordance with the in­clusion and exclusion criteria for this study was 9 articles. All articles found were used as sample.

Results: The average sensitivity and specificity values of the GCS instrument and FOUR Score were close to 1 or 100%. From the 8 articles found, all got sensitivity and specificity values by >50%.

Conclusion: The FOUR instrument score can be used as a substitute for GCS to assess the level of patient consciousness with patient outcomes (death) in ICU.

Keywords: glasgow coma scale, full outline of unresponsiveness score, outcome

Correspondence: Ika Silvitasari. School of Health Sciences Aisyiyah, Surakarta, Central Java. Jl. Ki Hajar Dewantara 10, Surakarta 57126, Central Java. Email: mouse_02april­

Indonesian Journal of Medicine (2019), 4(4): 339-345


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