FOUR Score (Full Outline of UnResponsiveness)
Assesses level of consciousness in non-verbal or intubated patients. Scores eye response, motor response, brainstem reflexes, and respiration. Avoids limitations of the verbal GCS component.
Score interpretation
FOUR Score 0 — consistent with brain death criteria. Vegetative or brain dead.
→ Brain death testing protocol if suspected; neurology/intensivist assessment; organ donation discussion if appropriate; family meeting
FOUR Score 1–7 — severe neurological impairment
→ Intensive neurological monitoring; ICP monitoring if TBI; neuroprotective care; early neurorehabilitation assessment
FOUR Score 8–12 — moderate neurological impairment
→ Neurological observation; serial assessments; consider step-down if improving; rehabilitation
FOUR Score 13–16 — mild or no significant neurological impairment
→ Standard neurological monitoring; assess recovery trajectory
Interpretation bands for the FOUR Score. Apply clinical judgement and local guidance.
References
- Wijdicks EF et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58(4):585–593.
Related
Curated clinical cross-links plus same-class fallbacks.
- 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
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.