FOUR score


Full Outline of UnResponsiveness


Eye response
  • E4: eyelids open or opened, tracking, or blinking to command
  • E3: eyelids open but not tracking
  • E2: eyelids closed but open to loud voice
  • E1: eyelids closed but open to pain
  • E0: eyelids remain closed with pain
Motor response
  • M4: thumbs-up, fist or peace sign
  • M3: localizing to pain
  • M2: flexion response to pain
  • M1: extension response to pain
  • M0: no response to pain or generalized myoclonus status
Brainstem reflexes
  • B4: pupil and corneal reflexes present
  • B3: one pupil wide and fixed
  • B2: pupil or corneal reflexes absent
  • B1: pupil and corneal reflexes absent
  • B0: absent pupil, corneal and cough reflex
Respiration pattern
  • R4: not intubated, regular breathing pattern
  • R3: not intubated, Cheyne-Stokes breathing pattern
  • R2: not intubated, irregular breathing
  • R1: breathes above ventilatory rate
  • R0: breathes at ventilator rate or apnea





Reference

Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EFM. Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc 2009; 84:694-701.