The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired

level of consciousness An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousne ...

. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in

Neurocritical care Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury. History There have been many attempts to manage head injur ...

at the

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

Rochester, Minnesota Rochester is a city in the U.S. state of Minnesota and the county seat of Olmsted County. Located on rolling bluffs on the Zumbro River's south fork in Southeast Minnesota, the city is the home and birthplace of the renowned Mayo Clinic. Acco ...

. "FOUR" in this context is an

acronym An acronym is a word or name formed from the initial components of a longer name or phrase. Acronyms are usually formed from the initial letters of words, as in ''NATO'' (''North Atlantic Treaty Organization''), but sometimes use syllables, as ...

for "Full Outline of UnResponsiveness". The FOUR Score is a 17-point scale (with potential scores ranging from 0 - 16). Decreasing FOUR Score is associated with worsening

. The FOUR Score assesses four domains of neurological function: eye responses, motor responses, brainstem reflexes, and breathing pattern. The rationale for the development of the FOUR Score constituted creation of a clinical grading scale for the assessment of patients with impaired

that can be used in patients with or without

endotracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...

. The main clinical grading scale in use for patients with impaired level of consciousness has historically been the

Glasgow Coma Scale The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These thre ...

(GCS), which cannot be administered to patients with an endotracheal tube (one component of the GCS is the assessment of verbal responses, which are not possible in the presence of an endotracheal tube). The FOUR score has been validated with reference to the Glasgow Coma Scale in several clinical contexts, including assessment by physicians in the Neurocritical Care Unit, assessment by intensive care nurses, assessment of patients in the medical intensive care unit (ICU), and assessment of patients in the

Emergency Department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...

. Comparison of the inter-observer reliability of the FOUR Score and the GCS suggests that the FOUR Score may have a modest but significant advantage in this particular measure of test function. Overall, FOUR score has better biostatistical properties than

in terms of sensitivity, specificity, accuracy and positive predictive value.

References

{{Reflist Diagnostic intensive care medicine Neurological disorders Mayo Clinic Medical scales

See also

References