Neurocritical Care

, Volume 15, Issue 3, pp 447–453 | Cite as

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

  • Marie-Aurélie Bruno
  • Didier Ledoux
  • Bernard Lambermont
  • François Damas
  • Caroline Schnakers
  • Audrey Vanhaudenhuyse
  • Olivia Gosseries
  • Steven LaureysEmail author
Original Article



The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liège Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state.


FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) brain-damaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Inter-rater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136).


GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit.


The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales.


Coma Full Outline of UnResponsiveness Glasgow Coma Scale Glasgow Liège Scale Vegetative state Minimally conscious state Neurological assessment Intensive care 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Marie-Aurélie Bruno
    • 1
  • Didier Ledoux
    • 1
  • Bernard Lambermont
    • 2
  • François Damas
    • 3
  • Caroline Schnakers
    • 1
  • Audrey Vanhaudenhuyse
    • 1
  • Olivia Gosseries
    • 1
  • Steven Laureys
    • 1
    Email author
  1. 1.Coma Science Group, Cyclotron Research Centre and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
  2. 2.Intensive Care DepartmentLiège University Hospital and University of LiègeLiègeBelgium
  3. 3.Intensive Care Department, Centre Hospitalier Régional de la CitadelleUniversity of LiègeLiègeBelgium

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