FOUR (Full Outline of UnResponsiveness) Score
Grades coma severity; may be more accurate than the Glasgow Coma Scale.
INSTRUCTIONS
Grade the best response in each category.
When to Use
Pearls/Pitfalls
Why Use
Eyelids open or opened, tracking, or blinking to command
+4Eyelids open but not tracking
+3Eyelids closed but open to loud voice
+2Eyelids closed but open to pain
+1Eyelids remain closed with pain
0Thumbs-up, fist, or peace sign
+4Localizing to pain
+3Flexion response to pain
+2Extension response to pain
+1No response to pain or generalized myoclonus status
0Pupil and corneal reflexes present
+4One pupil wide and fixed
+3Pupil OR corneal reflex absent
+2Pupil AND corneal reflexes absent
+1Absent pupil, corneal, and cough reflexes
0Not intubated, regular breathing pattern
+4Not intubated, Cheyne-Stokes breathing pattern
+3Not intubated, irregular breathing
+2Breathes above ventilatory rate
+1Breathes at ventilator rate or apnea
0Result:
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Evidence
Creator Insights
- Victor Lin, MD
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