Wijdicks et al developed the Full Outline of
UnResponsiveness (FOUR) score to assess a patient in coma. This has several
advantages over the Glasgow Coma Score but is more complex to administer. The
authors are from the Mayo Clinic.
|
Response
|
Findings
|
Points
|
|
eye response
|
eyelids open and tracking, or blinking on command
|
4
|
|
|
eyelids open but not tracking
|
3
|
|
|
eyelids closed but open to loud voice
|
2
|
|
|
eyelids closed but open to pain
|
1
|
|
|
eyelids closed with pain
|
0
|
|
motor response
|
makes sign (thumbs-up, fist, other)
|
4
|
|
|
localizing to pain
|
3
|
|
|
flexion response to pain
|
2
|
|
|
extension response to pain
|
1
|
|
|
no response to pain
|
0
|
|
|
generalized myoclonus status
|
0
|
|
Intubation
|
Breathing
|
Respiratory Points
|
|
not intubated
|
regular
|
4
|
|
not intubated
|
Cheyne-Stokes
|
3
|
|
not intubated
|
irregular
|
2
|
|
not intubated
|
apnea
|
0
|
|
intubated
|
above ventilator rate
|
1
|
|
intubated
|
breathes at ventilator rate
|
0
|
• The lower the score the greater the coma.
• The
inter-relater reliability was reported as good to excellent. Whether this
extends to casual users needs to be determined.
• The curve for
prediction of in-hospital death (Figure 3, page 592) shows better
discrimination for the FOUR score. The curve for prediction of a Rankin score
of 3-6 look fairly comparable.