Background: One of the challenging problem in routine critical care practice is management of patients with impairment of consciousness to determine the prognostic factors that predict final outcome in these patient with Loss Of Consciousness (LOC). GCS (Glasgow Coma Scale) is the best known and widely accepted as a scale for evaluation and as a predictor of prognosis in these patients. So, we were going to compare GCS and FOUR for this subject.

Materials and Methods: 65 adults patients since 22 June 2013 to 22 June 2014, who hospitalized in critical care units of two hospitals of Tehran city with GCS ≤ 9 were selected. We prospectively, evaluated the patients. GCS and FOUR scores were obtained on admission, week two, and follow up the patients after one month. In addition APACHE4 was performed on admission day. Finally, outcomes were evaluated for all patients. At the end, GCS and FOUR and component of them in prediction of prognosis were compared and both of them in evaluation and prediction of outcome were compared with APACHE4.

Results: Of the 65 patients (M:F=%47.7:%52.3 age 64±20 year), have been analyzed %18.5(12) patients discharged with goodness, %40(26) patients with neurological deficit and %41.5(27) had expired. During and after one month result showed Four is better than GCS in the first evaluation for predicting death and dependent life. GCS & Four is the same in the first & serial evaluation. in the first evaluation motor response by GCS and brain stem reflex by FOUR is better than the other components for this aim and the next evaluation these components performed as well as the total scores.

Conclusion: Both of scales are good predictor, But according to current research FOUR score can be better than GCS in predict of mortality and neurological deficit rate.