Full Outline of UnResponsiveness (FOUR) Score

Assesses the state of consciousness with a focus on brainstem reflexes and breathing patterns for detailed neurological evaluation.

Clinical parameters

Eye Response

No response0Eye opening to pain+1Eye opening to voice+2Spontaneous eye opening without tracking+3Spontaneous eye opening with blinking and tracking+4

Required

Motor Response

Absent or myoclonus0Extension to pain+1Flexion to pain+2Localizes pain+3Obeys commands+4

Required

Brainstem Reflexes

Pupillary, corneal, and cough reflexes absent0Pupillary and corneal reflexes absent+1Either pupillary or corneal reflex absent+2One pupil dilated and unreactive to light+3Pupillary and corneal reflexes preserved+4

Required

Respiration

Mechanical ventilation or apnea0Mechanical with spontaneous breaths+1Spontaneous, irregular breathing+2Cheyne-Stokes respiration+3Spontaneous, normal, effective breathing+4

Required

Score result

0 of 4 score components complete0 / 4

0 / 4

Complete all required parameters to calculate the score.

Still required

Eye Response
Motor Response
Brainstem Reflexes
Respiration

Clinical context

Compared with GCS, the FOUR Score includes brainstem reflexes and respiratory pattern assessment, and it remains usable when verbal response cannot be tested (for example, intubated patients). Total score ranges from 0 to 16.