ToolsCalculators
FOUR (Full Outline of UnResponsiveness) score
Coma assessment usable in intubated patients.
FOUR (Full Outline of UnResponsiveness) score
Eye response
Motor response
Brainstem reflexes
Respiration
Result16 / 16
Higher scores indicate greater responsiveness; a score of 0 reflects the most impaired state and carries the highest in-hospital mortality.
- FOUR score (0-16)
- 16
When to use
- Grading consciousness in critically ill or intubated patients where the verbal GCS component cannot be tested.
- Detecting locked-in syndrome and brainstem dysfunction that GCS may miss.
Formula
Sum of four components each scored 0-4: eye response, motor response, brainstem reflexes, and respiration. Range 0-16.
Pearls and pitfalls
- Unlike GCS, the FOUR score does not require a verbal response, making it valid in intubated patients and able to identify brainstem reflex loss.