Exam

FOUR Score Coma Exam

search

FOUR Score Coma Exam, Full Outline of Unresponsiveness, FOUR Score

  • See Also
  1. Coma Exam
  2. Coma
  • Criteria
  • Calculate total points (4 scores totaling 16 points)
  1. Eye Response
    1. Score 4: Eyelids open or opened, tracks and blinks to command
    2. Score 3: Eyelids open but are not tracking
    3. Score 2: Eyelids close but open with loud voice
    4. Score 1: Eyelids closed but open to pain
    5. Score 0: Eyelids remain closed despite painful stimuli
  2. Motor Response
    1. Score 4: Makes thumbs up, fist or peace sign
    2. Score 3: Localizes to pain
    3. Score 2: Flexion in response to pain
    4. Score 1: Extension in response to pain
    5. Score 0: No response to pain OR generalized Myoclonus
  3. Brainstem Reflex
    1. Score 4: Pupil reflex AND Corneal Reflex present
    2. Score 3: One pupil reflex fixed and widely dilated
    3. Score 2: Pupil OR Corneal Reflex absent
    4. Score 1: Pupil reflex AND Corneal Reflex absent
    5. Score 0: Pupil reflex, Corneal Reflex and cough reflex absent
  4. Respiration
    1. Score 4: Not intubated, regular breathing pattern
    2. Score 3: Not intubated, Cheyne-Stokes breathing pattern
    3. Score 2: Not intubated, irregular breathing pattern
    4. Score 1: Breathes above Ventilator rate
    5. Score 0: Breathes at Ventilator rate or apnea
  • References
  1. Wijdicks (2005) Ann Neurol 58(4): 585-93 +PMID:16178024 [PubMed]