ArticleCureus2025
Assessing the Efficacy of the FOUR (Full Outline of Unresponsiveness) Score in Diabetic Ketoacidosis-Induced Altered Mental Status.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Introduction Altered mental status (AMS) is a critical presentation in diabetic ketoacidosis (DKA). Although the Glasgow Coma Scale (GCS) is the standard tool for evaluating consciousness, it has limitations when used in critically ill patients. The Full Outline of UnResponsiveness (FOUR) score, designed to address these, has been studied in neurocritical settings but remains underexplored in metabolic encephalopathies. This study aimed to compare the prognostic utility of GCS and FOUR scores in hyperglycemia-induced AMS. Materials and methods A cross-sectional pilot study was carried out at Madras Medical College involving 91 DKA patients with AMS. Baseline demographics, metabolic parameters, GCS, and FOUR scores were documented. Statistical analyses included Spearman's correlation, regression models, and ordinal regression to identify associations between neuro-metabolic parameters and neurological outcomes. Ethical approval was obtained, and informed consent was secured from legally authorized representatives. Results Patients demonstrated severe metabolic derangements (mean glucose: 566 mg/dL, pH: 7.05, HCO₃-
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