FOUR Score

Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Introduced the Full Outline of UnResponsiveness (Eye, Motor, Brainstem, Respiration; each 0–4). It had good inter-rater agreement and predicted in-hospital mortality, and a FOUR score of 0 discriminated the lowest GCS patients better than the GCS alone.

The FOUR score is recommended where the GCS verbal component cannot be assessed (intubation, aphasia). Lower totals track with higher in-hospital and long-term mortality and worse functional outcome; component scores of 0 (especially brainstem and respiration) carry particular weight.