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Eye Response (E)
Motor Response (M)
Brainstem Reflexes (B)
Respiration (R)
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About

The Full Outline of UnResponsiveness (FOUR) Score is a neurological grading scale designed to assess patients with impaired consciousness. Unlike the Glasgow Coma Scale (GCS), the FOUR score does not rely on a verbal response, making it superior for intubated or aphasic patients. It provides greater neurological detail by explicitly evaluating brainstem reflexes and respiratory patterns, which aids in identifying the stages of herniation and locking-in syndrome.

neurology coma scale GCS alternative intubated patients brainstem

Formulas

The Total FOUR Score is the summation of four components:

Score = E + M + B + R

Maximum Score: 16 (Fully conscious).
Minimum Score: 0 (Deep coma/Brain death probable).

Reference Data

CategoryScoreDescription
Eye4Eyelids open or opened, tracking, or blinking to command
0Eyelids remain closed with pain
Motor4Thumbs-up, fist, or peace sign
0No motor response or generalized myoclonus
Brainstem4Pupil and corneal reflexes present
0Absent pupil, corneal, and cough reflex
Respiration4Regular breathing pattern (not intubated)
0Apnea or breathes at ventilator rate

Frequently Asked Questions

GCS is limited in intubated patients because the "Verbal" component cannot be assessed. FOUR replaces Verbal with Respiration and Brainstem reflexes, providing a valid score for intubated patients without losing prognostic power.
A score of 0 indicates non-functioning brainstem and apnea, which is highly correlated with brain death. Immediate formal testing for brain death may be warranted.