FOUR (Full Outline of UnResponsiveness) Score
Grades coma severity; may be more accurate than the Glasgow Coma Scale.
Grade the best response in each category.
When to Use
Eyelids open or opened, tracking, or blinking to command+4
Eyelids open but not tracking+3
Eyelids closed but open to loud voice+2
Eyelids closed but open to pain+1
Eyelids remain closed with pain0
Thumbs-up, fist, or peace sign+4
Localizing to pain+3
Flexion response to pain+2
Extension response to pain+1
No response to pain or generalized myoclonus status0
Pupil and corneal reflexes present+4
One pupil wide and fixed+3
Pupil OR corneal reflex absent+2
Pupil AND corneal reflexes absent+1
Absent pupil, corneal, and cough reflexes0
Not intubated, regular breathing pattern+4
Not intubated, Cheyne-Stokes breathing pattern+3
Not intubated, irregular breathing+2
Breathes above ventilatory rate+1
Breathes at ventilator rate or apnea0
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- Victor Lin, MD
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