🧠 FOUR Score (Coma Assessment)
UseGrade coma, including in intubated patients where GCS verbal cannot be tested.
SourceWijdicks EFM, et al. Ann Neurol 2005. doi:10.1002/ana.20611
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Usable in intubated patients (no verbal component).
When to use
Grade coma, including in intubated patients where GCS verbal cannot be tested.
How it works
Four components (Eye, Motor, Brainstem reflexes, Respiration) each 0–4; total 0–16. Lower scores indicate deeper coma.
Key points
- Usable in intubated patients (no verbal component).
- Captures brainstem reflexes and breathing pattern.
- Lower totals predict worse outcomes.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Eye response | Opens to loud voice (2) |
|---|---|
| Motor response | Flexion to pain (2) |
| Brainstem reflexes | Pupil or corneal absent (2) |
| Respiration | Not intubated, irregular (2) |
→FOUR score8/16
- Note：Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.
| Eye response | Open, tracking/blinking to command (4) |
|---|---|
| Motor response | Thumbs up/fist/peace sign (4) |
| Brainstem reflexes | Pupil & corneal present (4) |
| Respiration | Not intubated, regular (4) |
→FOUR score16/16
- Note：Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using FOUR Score (Coma Assessment)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does FOUR Score (Coma Assessment) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is FOUR Score (Coma Assessment) calculated in practice? Can you show a worked example?
- Inputs: Eye response Opens to loud voice (2), Motor response Flexion to pain (2), Brainstem reflexes Pupil or corneal absent (2), Respiration Not intubated, irregular (2) → Result: FOUR score 8 /16（Note: Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.） Inputs: Eye response Open, tracking/blinking to command (4), Motor response Thumbs up/fist/peace sign (4), Brainstem reflexes Pupil & corneal present (4), Respiration Not intubated, regular (4) → Result: FOUR score 16 /16（Note: Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.）