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 1).
The predictive value of the FOUR score on admission of patients with TBI is no better than the GCS score 2).
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