Critical Care

FOUR Score (Coma)

Full Outline of UnResponsiveness — coma severity.

Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.

When to use

Use to assess consciousness in critically ill patients, including those who are intubated where GCS verbal scoring is not possible.

Why use

It works in intubated patients and captures brainstem reflexes and breathing, unlike the GCS.

Advice

Lower scores indicate worse consciousness. A FOUR score of 0 carries the gravest prognosis. Use alongside full clinical assessment.

Evidence & references

  1. Wijdicks EF et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005.

About the creator

Wijdicks EF et al.

Related calculators

Glasgow Coma Scale (GCS)Level of consciousness from eye, verbal and motor response.4AT (Delirium Screen)Rapid bedside test for delirium.

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