FOUR score
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 myoclonic status epilepticus
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
Respiration
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
References
Validation of a new coma scale: The FOUR score. Ann Neurol. 2005 Oct;58(4):585-93
doi:
10.1002/ana.20611
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