FOUR score
Neurology
Also known as: Full Outline of UnResponsiveness score · FOUR-Score · FOUR skoru · FOUR score (Full Outline of UnResponsiveness)
What it is for
FOUR score: coma scale with four components (eye, motor, brainstem reflexes, respiration), each 0-4, total 0-16; unlike the GCS it needs no verbal response and includes brainstem signs.
Classification
| Category | Description |
|---|---|
| Eye (E) | 4 eyelids open or opened, tracking or blinking to command; 3 open but not tracking; 2 closed, open to loud voice; 1 closed, open to pain; 0 remain closed with pain. |
| Motor (M) | 4 thumbs-up, fist or peace sign to command; 3 localises pain; 2 flexion to pain; 1 extension to pain; 0 no response to pain or generalised myoclonus status. |
| Brainstem (B) | 4 pupil and corneal reflexes present; 3 one pupil wide and fixed; 2 pupil or corneal reflexes absent; 1 pupil and corneal reflexes absent; 0 pupil, corneal and cough reflexes absent. |
| Respiration (R) | 4 not intubated, regular breathing; 3 not intubated, Cheyne-Stokes breathing; 2 not intubated, irregular breathing; 1 breathes above the ventilator rate; 0 breathes at the ventilator rate or apnoea. |
| Total | 0 to 16; lower means deeper unresponsiveness. |
Source
Validation of a new coma scale: The FOUR score
Ann Neurol 2005;58:585–593 (Wijdicks EFM et al.)
DOI: 10.1002/ana.20611
PMID: 16178024
- Edition
- FOUR score (Wijdicks et al. 2005)
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