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FOUR Full Outline of UnResponsiveness Score

Eye Response

Findings

Score

eyelids open and tracking, or blinking on command

4

eyelids open but not tracking

3

eyelids closed but open to loud voice

2

eyelids closed but open to pain

1

eyelids closed with pain

0

Motor Response

Findings

Score

makes sign (thumbs-up, fist, other)

4

localizing to pain

3

flexion response to pain

2

extension response to pain

1

no response to pain

0

generalized myoclonus status

0

Pupil Reflexes

Corneal Reflexes

Cough

Brainstem Score

present

present

present

4

one pupil wide and fixed

present

present

3

absent

present

NA

2

present

absent

NA

2

absent

absent

present

1

absent

absent

absent

0

Intubation

Breathing

Respiratory Score

not intubated

regular

4

not intubated

Cheyne-Stokes

3

not intubated

irregular

2

not intubated

apnea

0

intubated

above ventilator rate

1

intubated

breathes at ventilator rate

0

total score =

= SUM (points for all 4 parameters)


Interpretation:

minimum score: 0

maximum score: 16

The lower the score the greater the coma



Source:

Wijdicks EFM, Bamler WR, et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005; 58: 585-593


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