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Harrison's Principles of Internal Medicine - 19th Edition (April 17, 2015)

Home Criteria Critical Care FOUR Score for Comatose Patients


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FOUR Score for Comatose Patients Print E-mail
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Written by G. Firman MD   
Wednesday, 25 February 2009 03:11

Eye response

4 = eyelids open or opened, tracking, or blinking to command

3 = eyelids open but not tracking

2 = eyelids closed but open to loud voice

1 = eyelids closed but open to pain

0 = eyelids remain closed with pain

Motor response

4 = thumbs-up, fist, or peace sign

3 = localizing to pain

2 = flexion response to pain

1 = extension response to pain

0 = no response to pain or generalized myoclonus status

Brainstem reflexes

4 = pupil and corneal reflexes present

3 = one pupil wide and fixed

2 = pupil or corneal reflexes absent

1 = pupil and corneal reflexes absent

0 = absent pupil, corneal, and cough reflex


4 = not intubated, regular breathing pattern

3 = not intubated, Cheyne–Stokes breathing pattern

2 = not intubated, irregular breathing

1 = breathes above ventilator rate

0 = breathes at ventilator rate or apnea

FOUR = Full Outline of UnResponsiveness.




  1. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005 Oct;58(4):585-93. [Medline]

  2. Wijdicks EF. Clinical Scales for Comatose Patients: The Glasgow Coma Scale in Historical Context and the New FOUR Score. Rev Neurol Dis. 2006 Fall;3(3):109-17. [Medline]


Created: Jan 29, 2007

Last Updated on Saturday, 30 August 2014 12:36

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