FOUR Score [Neurosurgery Wiki]

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====== FOUR Score ======

Considering that FOUR score allows a more detailed neurological evaluation than [[GCS]].
Findings suggest that FOUR score is more useful for patients who are unconscious or dependent on mechanical ventilation
((Bayraktar YŞ, Sahinoglu M, Cicekci F, Kara İ, Karabagli H, Duman A, Celik JB. 
COMPARISON OF GLASGOW COMA SCALE AND FULL OUTLINE OF UNRESPONSIVENESS (FOUR)
SCORE: A PROSPECTIVE STUDY. Turk Neurosurg. 2018 Oct 12. doi:
10.5137/1019-5149.JTN.24175-18.2. [Epub ahead of print] PubMed PMID: 30649827.
)).

The predictive value of the [[FOUR score]] on admission of patients with TBI is no better than the [[GCS]] score
((Saika A, Bansal S, Philip M, Devi BI, Shukla DP. Prognostic value of FOUR and 
GCS scores in determining mortality in patients with traumatic brain injury. Acta
Neurochir (Wien). 2015 Sep;157(8):1323-8. doi: 10.1007/s00701-015-2469-6. Epub
2015 Jun 16. PubMed PMID: 26077394.
)).

Eye Response	Findings	Score

eyelids open and tracking, or blinking on command	4

eyelids open but not tracking	3

eyelids closed but open to loud voice	2

eyelids closed but open to pain	1

eyelids closed with pain	0




Motor Response	Findings	Score

makes sign (thumbs-up, fist, other)	4

localizing to pain	3

flexion response to pain	2

extension response to pain	1

no response to pain	0

generalized myoclonus status	0




Pupil Reflexes	Corneal Reflexes	Cough	Brainstem Score

present	present	present	4

one pupil wide and fixed	present	present	3

absent	present	NA	2

present	absent	NA	2

absent	absent	present	1

absent	absent	absent	0




Intubation	Breathing	Respiratory Score

not intubated	regular	4

not intubated	Cheyne-Stokes	3

not intubated	irregular	2

not intubated	apnea	0

intubated	above ventilator rate	1

intubated	breathes at ventilator rate	0




total score =

= SUM (points for all 4 parameters)


Interpretation:

minimum score: 0

maximum score: 16

The lower the score the greater the coma


Source:

Wijdicks EFM, Bamler WR, et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005; 58: 585-593