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FOUR Coma Score

Eyes
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Eyes
No eye opening to pain
Eyes closed but open to pain
Eyes closed but open to loud voice
Eyes open but no tracking
Eyes open, tracking or blinking to command
Motor
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Motor
No response to pain or generalized myoclonus status
Extension response
Flexion response to pain
Localizes to pain
Thumbs up, fist, or peace sign
Brainstem
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Brainstem
No reflexes (pupil, corneal, and cough)
No pupil and corneal reflexes
No pupil or corneal reflex
One pupil wide and fixed
Pupil and corneal reflexes present
Respiration
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Respiration
Apnea or fully ventilator dependent
Triggers ventilator or breathes above ventilator rate
Abnormal breathing pattern
Cheyne-Stokes breathing pattern
Regular breathing pattern
Score:

Result Interpretation

The Glasgow Coma Scale (GCS) is the most widely used method for assessing coma, but it has some limitations, including its inability to assess intubated patients and brainstem reflexes.

The FOUR (Full Outline of Unresponsiveness) score is a newly developed coma score that overcomes these limitations and provides more detailed information to assess the level of coma, and it can be used for intubated patients.

References

Research Paper Stead LG. Neurocrit Care. 2009;10(1):50-4.
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