The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the

Mayo Clinic Mayo Clinic () is a Nonprofit organization, private American Academic health science centre, academic Medical centers in the United States, medical center focused on integrated health care, healthcare, Mayo Clinic College of Medicine and Science ...

Rochester, Minnesota Rochester is a city in Olmsted County, Minnesota, United States, and its county seat. It is located along rolling bluffs on the Zumbro River's south fork in Southeast Minnesota. At the 2020 United States census, 2020 census, the city had a popul ...

. "FOUR" in this context is an

acronym An acronym is a type of abbreviation consisting of a phrase whose only pronounced elements are the initial letters or initial sounds of words inside that phrase. Acronyms are often spelled with the initial Letter (alphabet), letter of each wor ...

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 level of consciousness. 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 level of consciousness that can be used in patients with or without endotracheal intubation. The main clinical grading scale in use for patients with impaired level of consciousness has historically been the Glasgow Coma Scale (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 (medicine), ...

. 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 Glasgow Coma Scale 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