Full Outline of UnResponsiveness (FOUR Score)
Assesses level of consciousness, including in people who cannot speak.
By Claire White
- Clinician-administered, usable at the bedside even when a person is intubated.
- Four components (eye, motor, brainstem reflexes, and respiration), each scored 0 to 4.
- The total runs from 0 to 16.
What it measures
The FOUR Score rates four parts of the neurological exam: the eye response, motor response, brainstem reflexes, and breathing pattern. It can be used when a person is intubated or cannot speak, where some other scales cannot.
What the result tells you
Each component is scored from 0 to 4 for a total of 0 to 16, giving a profile of consciousness and brainstem function. A lower score predicts higher mortality. It is reference information, tracked over time.
Used for
Evidence, psychometrics and provenance
Created by Wijdicks and colleagues in 2005.
Psychometrics
Inter-rater reliabilityWeighted κ ≈ 0.82
Inter-rater agreement on a 0 to 1 scale; higher in later ICU and ED studies.
- Mortality prediction
- Lower score predicts higher in-hospital mortality
References
- 1.Wijdicks EFM, et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58(4):585-593.
- 2.Wolf CA, et al. Further validation of the FOUR score coma scale by intensive care nurses. Mayo Clin Proc. 2007;82(4):435-438.
- 3.Iyer VN, et al. Validity of the FOUR score coma scale in the medical ICU. Mayo Clin Proc. 2009;84(8):694-701.
This assessment uses a validated instrument and is reference information, not a diagnosis.