Full Outline of UnResponsivenes (FOUR) score

FOUR Score

Full Outline of UnResponsivenes (FOUR) score
E4 = eyelids open or opened, tracking, or blinking to command
E3 = eyelids open but not tracking
E2 = eyelids closed but open to loud voice
E1 = eyelids closed but open to pain
E0 = eyelids remain closed with pain

M4 = thumbs-up, fist, or peace sign
M3 = localizing to pain
M2 = flexion response to pain
M1 = extension response to pain
M0 = no response to pain or generalized myoclonus status

Brainstem reflexes:
B4 = pupil and corneal reflexes present
B3 = one pupil wide and fixed
B2 = pupil or corneal reflexes absent
B1 = pupil and corneal reflexes absent
B0 = absent pupil, corneal, and cough reflex

Respiration pattern:
R4 = not intubated, regular breathing pattern
R3 = not intubated, Cheyne-Stokes breathing pattern
R2 = not intubated, irregular breathing
R1 = breathes above ventilatory rate
R0 = breathes at ventilator rate or apnea


Kiwon Lee, NeuroICU Book.

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