The Full Outline of UnResponsiveness (FOUR) score provides greater neurological detail than the Glasgow Coma Scale (GCS), recognizes a locked-in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation.
Eye response
4 = eyelids open or opened, tracking, or blinking to command
3 = eyelids open but not tracking
2 = eyelids closed but open to loud voice
1 = eyelids closed but open to pain
0 = eyelids remain closed with pain
Motor response
4 = thumbs-up, fist, or peace sign
3 = localizing to pain
2 = flexion response to pain
1 = extension response to pain
0 = no response to pain or generalized myoclonus status
Brainstem reflexes
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 = absent pupil, corneal, and cough reflex
Respiration
4 = not intubated, regular breathing pattern
3 = not intubated, Cheyne–Stokes breathing pattern
2 = not intubated, irregular breathing
1 = breathes above ventilator rate
0 = breathes at ventilator rate or apnea
References:
- Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005 Oct;58(4):585-93. [Medline]
- Wijdicks EF. Clinical Scales for Comatose Patients: The Glasgow Coma Scale in Historical Context and the New FOUR Score. Rev Neurol Dis. 2006 Fall;3(3):109-17. [Medline]
Created: Jan 29, 2007