English (United Kingdom)Español (spanish formal Internacional)

MC Facebook


Home Criteria Critical Care FOUR Score for Comatose Patients


The content of this website is provided for general informational purposes only and is not a substitute professional medical advice

FOUR Score for Comatose Patients Print E-mail
User Rating: / 139
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

Free Registry



HONcode accreditation seal. We comply with the HONcode standard for health trust worthy information:
verify here

Site Last Modified

Wednesday 17 January 2018, 14:29


Copyright © 2005-2018. All Rights Reserved