FOUR and Glasgow scales as predictors of mortality in critical neuropathies in intensive care units

Objective: To compare the sensitivity, specificity and predictive capacity of the FOUR and Glasgow scales to predict mortality in patients with critical neuropathies in Intensive Care Units. Introduction: Neurological disorders are a common cause of admission to Intensive Care Units (ICU). Scales such as the Glasgow Coma Scale (GCS) and the FOUR scale are key tools for assessing the level of consciousness and predicting mortality. Determining which scale provides better results can help in understanding patient prognosis. Methods: A prospective cross-sectional study was conducted on 24 patients admitted to the ICU of the Regional Hospital of Cobán. Patients with neurological conditions were assessed using the GCS and FOUR scales. The data were analyzed using descriptive statistics, and sensitivity, specificity, and area under the curve (AUC) for both scales were calculated. Results: The overall mortality rate was 58%. The GCS scale showed a sensitivity of 86%, specificity of 50%, and an AUC of 0.72, while the FOUR scale reached a sensitivity of 92%, specificity of 90%, and an AUC of 0.91. The concordance between both scales was 70%, with a Kappa index of 0.58, indicating moderate agreement. FOUR demonstrated superior ability to identify cases of mortality and true negatives compared to GCS. Discussion: The FOUR scale stood out as a more accurate and reliable predictor of mortality in patients with neurocritical conditions. This is attributed to its ability to assess brainstem reflexes and respiratory patterns, areas not covered by the GCS. Both scales are useful and valid for neurological evaluation in ICU, however, FOUR offers superior performance in mortality prediction.