FOUR_Full_Outline_of_UnResponsiveness_Score_guideline v.1
FOUR (Full Outline of UnResponsiveness) Score grades coma severity; may be more accurate than the Glasgow Coma Scale. Formula: Addition of the selected points. Variables and correlated points are as below: Eye response: - Eyelids open or opened, tracking, or blinking to command=4 - Eyelids open but not tracking=3 - Eyelids closed but open to loud voice=2 - Eyelids closed but open to pain=1 - Eyelids remain closed with pain=0 Motor response (upper extremities): - Thumbs-up, fist, or peace sign=4 - Localizing to pain=3 - Flexion response to pain=2 - Extension response to pain=1 - No response to pain or generalized myoclonus status=0 Brainstem reflexes: - Pupil and corneal reflexes present=4 - One pupil wide and fixed=3 - Pupil OR corneal reflex absent=2 - Pupil AND corneal reflexes absent=1 - Absent pupil, corneal, and cough reflexes=0 Respiration pattern: - Not intubated, regular breathing pattern=4 - Not intubated, Cheyne-Stokes breathing pattern=3 - Not intubated, irregular breathing=2 - Not intubated, irregular breathing=1 - Breathes at ventilator rate or apnea=0 Interpretation: Lower scores indicate higher coma severity.
To evaluation of neurological status in critically ill patients, in particular, in terms of assessing for impending neurological decline (i.e., brainstem herniation) as well as clearer differentiation between comatose states (e.g. minimal conscious state, locked-in syndrome).
Use in critically ill patients to assess coma severity.
Not use to make clinical management decision in acute setting.
1. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, Mcclelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58(4):585-93.
OBSERVATION.full_outline_of_unresponsiveness_four_score.v0
