FOUR Score Calculator

FOUR Score Calculator for Neurology. The total summarizes neurological responsiveness. Review domain changes rather than treating equal totals as identical examinations.

For shared guidance on choosing a tool and documenting results, read the clinical calculator workflow.

How this calculator works

Add E, M, B and R, each 0-4, for a total 0-16. Original model identity: https://onlinelibrary.wiley.com/doi/10.1002/ana.20611 . Table 1 and examination conventions were checked in the full original paper: https://anest-rean.ru/wp-content/uploads/2026/03/Validation-of-a-New-Coma-Scale-The-FOUR-Score.pdf

When to use this calculator

Describe impaired consciousness using an assessable examination, including intubated patients. Medical ICU validation involved trained observers: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719522/

Inputs used

  • Confirmation all four domains are assessable
  • Best eye response
  • Best upper-limb motor response
  • Best brainstem reflex pattern
  • Respiratory pattern and ventilator interaction

Clinical interpretation

The total summarizes neurological responsiveness. Review domain changes rather than treating equal totals as identical examinations.

Worked example

Eye opening to loud voice E2, pain localization M3, preserved pupil/corneal reflexes B4 and breathing above the ventilator R1 gives 10. Retain the E2 M3 B4 R1 breakdown.

Limitations and safety notes

Sedation, paralysis, ocular injury and ventilation settings may make domains uninterpretable. Zero does not diagnose brain death; the full legally applicable examination and prerequisites are separate. No mortality percentage is assigned.

Frequently asked questions

Can I assign zero to an untestable domain?

No. An untestable domain is missing information, not the observed worst response. Mark the examination unassessable.

References

  • Wijdicks et al. Original FOUR validation, 2005: https://onlinelibrary.wiley.com/doi/10.1002/ana.20611
  • Original paper full-text copy; Table 1 and examination conventions: https://anest-rean.ru/wp-content/uploads/2026/03/Validation-of-a-New-Coma-Scale-The-FOUR-Score.pdf
  • Iyer et al. Medical ICU validation, 2009: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719522/

Editorial review and citation methodology

Maintained by the Quick Medical Calculator Editorial Team. Content record date: September 9, 2026. A content date is not evidence of independent clinical review. Individual clinical sign-off is not recorded on this page.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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