FOUR Score Coma Scale Calculator

Full Outline of UnResponsiveness (FOUR) Score for coma assessment (0–16).

For educational and clinical reference. Not a substitute for medical judgment. See the medical disclaimer.
Score
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Interpretation
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References

  1. Wijdicks EFM, Bamlet WR, Maramattom BV, et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58(4):585-593.

How to use

  1. Score eye response, motor response, brainstem reflexes, and respiration (0–4 each).
  2. The total (0–16) and interpretation update instantly.
  3. Re-assess at intervals — trend matters more than a single reading.

Frequently asked questions

What is the FOUR Score used for?

The Full Outline of UnResponsiveness (FOUR) Score assesses level of consciousness in critically ill patients, including those who are intubated where the verbal component of the Glasgow Coma Scale cannot be assessed.

Why use FOUR instead of GCS?

FOUR includes brainstem reflexes and respiration, making it sensitive to deeper coma and herniation. It can be used in intubated patients where GCS verbal score is unobtainable.

What range is the FOUR Score?

0 (worst) to 16 (best). Each of the 4 components scores 0–4.

How does FOUR predict mortality?

A FOUR score of 0 has been associated with very high in-hospital mortality. Scores ≤ 7 indicate severe brain dysfunction and increased mortality.

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