This study aims to compare the predictive accuracy of the Glasgow Coma Scale (GCS) and the Full Outline of Unresponsiveness (FOUR) Score in forecasting mortality in Hispanic patients with Traumatic Brain Injury (TBI).

TBI is a leading cause of mortality and long-term disability worldwide, particularly affecting low-income populations where access to timely medical care is often limited. Early identification of high-risk patients is crucial for optimizing clinical outcomes and enabling effective interventions. The GCS is the most widely used tool for assessing consciousness levels in TBI patients. However, it has limitations in certain clinical scenarios, which require alternative assessment tools like the FOUR Score.

We conducted a retrospective diagnostic accuracy study among Hispanic patients with TBI admitted to a tertiary care hospital in Ecuador, between 2018 and 2023. Upon admission, neurologists assessed both the GCS and FOUR Score. Mortality outcomes were recorded, and we evaluated the predictive accuracy of each scale using the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) analysis. We then compared the performance of the two scales to determine which more accurately predicted mortality in this population.

We included 199 patients (mean age: 37±19 years), with males comprising 85.5% (171) of the cohort. The overall mortality rate was 27.5% (55 patients). The AUC for the GCS was 0.602 (95% CI: 0.508-0.697, p=0.026). The FOUR Score demonstrated an AUC of 0.525 (95% CI: 0.439-0.611, p=0.582). Notably, both scales exhibited at least one tie between the positive and negative outcome groups.

The GCS demonstrated a statistically significant but modest predictive accuracy for mortality in trauma patients, while the FOUR Score did not show significant predictive value. The findings highlight the need for caution when using these scales alone for mortality prediction in trauma settings, and further studies may be required to validate their effectiveness.