🧠 FOUR Score (Coma Assessment)
Assess consciousness with the FOUR (Full Outline of UnResponsiveness) score.
Clinical takeaway
Usable in intubated patients (no verbal component).
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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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
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 | 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.
| Eye response | Remains closed (0) |
|---|---|
| Motor response | None or myoclonus (0) |
| Brainstem reflexes | Absent pupil, corneal & cough (0) |
| Respiration | Intubated, at vent rate/apnoea (0) |
→FOUR score0/16
- Note：Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.
Frequently asked questions
- What is FOUR Score (Coma Assessment)?
- Assess consciousness with the FOUR (Full Outline of UnResponsiveness) score.
- How is FOUR Score (Coma Assessment) calculated? What is the core formula?
- Four components (Eye, Motor, Brainstem reflexes, Respiration) each 0–4; total 0–16. Lower scores indicate deeper coma.
- When is FOUR Score (Coma Assessment) used?
- Grade coma, including in intubated patients where GCS verbal cannot be tested.
- What are the key clinical points for FOUR Score (Coma Assessment)?
- Usable in intubated patients (no verbal component). Captures brainstem reflexes and breathing pattern. Lower totals predict worse outcomes.
- 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.
- How is FOUR Score (Coma Assessment) calculated in practice? Can you show a worked example?
- 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.） Inputs: Eye response Remains closed (0), Motor response None or myoclonus (0), Brainstem reflexes Absent pupil, corneal & cough (0), Respiration Intubated, at vent rate/apnoea (0) → Result: FOUR score 0 /16（Note: Lower scores indicate deeper coma; a score of 0 supports brain-death evaluation.）