Neurology Book


FOUR Score Coma Exam

Aka: FOUR Score Coma Exam, Full Outline of Unresponsiveness, FOUR Score
  1. See Also
    1. Coma Exam
    2. Coma
  2. 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
  3. References
    1. Wijdicks (2005) Ann Neurol 58(4): 585-93 +PMID:16178024 [PubMed]

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