Background: Neurological disorders (NDs) that affect the nervous system as trauma to the brain as well as spinal cord. NDs are the main cause of disability and death in the world, and they affect consciousness. Assessment level of consciousness are done through Glasgow coma scale (GCS) and Full Outline of Unresponsiveness Scale (FOUR). Objective: The present study aimed to compare between FOUR and GCS. Patients and methods: A comparative exploratory study was conducted at Intensive Care Unit and surgical emergency at Elminya University Hospitals. A purposeful sampling yielded a total of 126 patients with traumatic brain injury (TBI) or traumatic spinal cord injury (TSCI) in adults. All participants were subjected to structured interview questionnaire, GCS, FOUR, and Glasgow Outcome Scale Extended (GOSE). Results: GCS and FOUR scores of the studied patients had a proper cut-off predictive value ≤12, but GCS was more specific and accurate than FOUR in the predictability of full recovery. Both scores were similar for the prediction of loss of consciousness (LOS) in hospital with the same cut-off ≤13 at the 24 hours. There was a statistically significant correlation between GOSE, GCS, and FOUR. Conclusion: GCS is the same as FOUR score in predicting clinical outcomes but FOUR can assess patients on mechanical ventilation and predict clinical outcomes for intubation, weaning of ventilator, and speech impairment. Predicting death and full recovery using the FOUR score is more accurate than using the GCS. Continuous Educational programs should be planned to ICU and using GCS and FOUR.