FOUR score for coma (Full Outline of Unresponsiveness)
Coma scale that works in intubated patients.
Inputs
0 of 4Eye response
Motor response
Brainstem reflexes
Respiration
When to use
- Comatose or intubated patients where verbal GCS is untestable.
Pearls and pitfalls
- Score 0 suggests brain death evaluation.
Why use
Adds brainstem reflexes and respiration to GCS.
| Criterion | Points |
|---|---|
| Eye response: Eyelids remain closed with pain | 0 |
| Closed, open to pain | +1 |
| Closed, open to loud voice | +2 |
| Open, not tracking | +3 |
| Open or opened, tracking or blinking to command | +4 |
| Motor response: No response or generalized myoclonus | 0 |
| Extension to pain | +1 |
| Flexion to pain | +2 |
| Localizing to pain | +3 |
| Thumbs-up, fist, or peace sign | +4 |
| Brainstem reflexes: Absent pupil, corneal, and cough reflexes | 0 |
| Pupil and corneal reflexes absent | +1 |
| Pupil or corneal reflexes absent | +2 |
| One pupil wide and fixed | +3 |
| Pupil and corneal reflexes present | +4 |
| Respiration: Breathes at ventilator rate or apnea | 0 |
| Breathes above ventilator rate | +1 |
| Not intubated, irregular breathing | +2 |
| Not intubated, Cheyne-Stokes | +3 |
| Not intubated, regular breathing | +4 |