{"id":45,"date":"2009-02-25T11:11:40","date_gmt":"2009-02-25T11:11:40","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/neurofour\/"},"modified":"2025-05-14T21:02:16","modified_gmt":"2025-05-14T21:02:16","slug":"neurofour","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/neurofour\/","title":{"rendered":"FOUR Score for Comatose Patients"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>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.<!--more--><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>Eye response <\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">4 = eyelids open or opened, tracking, or blinking to command<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">3 = eyelids open but not tracking<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">2 = eyelids closed but open to loud voice<br \/>\n1 = eyelids closed but open to pain<\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">0 = eyelids remain closed with pain<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>Motor response <\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">4 = thumbs-up, fist, or peace sign<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">3 = localizing to pain<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">2 = flexion response to pain<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">1 = extension response to pain<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\">0 = no response to pain or generalized myoclonus status<\/p>\n<p><strong>Brainstem reflexes <\/strong><br \/>\n4 = pupil and corneal reflexes present<br \/>\n3 = one pupil wide and fixed<br \/>\n2 = pupil or corneal reflexes absent<br \/>\n1 = pupil and corneal reflexes absent<br \/>\n0 = absent pupil, corneal, and cough reflex<\/p>\n<p><strong>Respiration<\/strong><br \/>\n4 = not intubated, regular breathing pattern<br \/>\n3 = not intubated, Cheyne\u2013Stokes breathing pattern<br \/>\n2 = not intubated, irregular breathing<br \/>\n1 = breathes above ventilator rate<br \/>\n0 = breathes at ventilator rate or apnea<\/p>\n<\/div>\n<div class=\"Section1\">\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<\/div>\n<ol style=\"font-weight: 400;\">\n<li>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.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16178024\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>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.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17047576\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Jan 29, 2007<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[148],"tags":[1286,1285,1861,650,1300,990,973,450,1375],"class_list":["post-45","post","type-post","status-publish","format-standard","hentry","category-critical-care","tag-coma","tag-comatose","tag-comatosos","tag-four","tag-neurology","tag-pacientes","tag-patients","tag-score","tag-uti"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/45","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=45"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/45\/revisions"}],"predecessor-version":[{"id":9371,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/45\/revisions\/9371"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=45"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=45"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=45"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}