FOUR Score (Full Outline of UnResponsiveness)
Coma scale assessing eye response, motor response, brainstem reflexes, and respiration. Outperforms GCS for intubated patients.
Score interpretation
→ Close monitoring; investigate cause; reassess frequently
→ Airway protection; ICU monitoring; urgent neuroimaging
→ ICU; consider intubation; neuroprognostication; family discussion
→ Formal brain death assessment; organ donation discussion
Interpretation bands for the FOUR Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Dimeticone · Topical pediculicide (silicone-based)
- Sodium phenylbutyrate · Ammonia scavenger (alternative pathway)
- Docusate sodium · Stool softener (anionic surfactant)
- Erythromycin · First-Generation Macrolide — Penicillin Allergy Alternative / Gastroparesis Prokinetic
- Chloramphenicol · Amphenicol — Meningitis (Alternative) / Topical Eye Infections
- Teicoplanin (Burns — MRSA Alternative) · Antibiotic — Glycopeptide
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Featured in these MRCEM clinical pathways
The FOUR Score is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.