Nevertheless, “there are some real pluses with it–most importantly, looking for pupil changes and corneal responses. That's a real important improvement over the Glasgow score.” The FOUR scale may be a good supplement to the GCS in some specific areas, but probably won't supplant it, Dr. Teasdale said. “It must and will remain as a basic universal language. However, one of its benefits is its flexibility so it can be adapted, which is the essence of what Dr. Wijdicks has done, as have others in the past.”
Scoring the Full Outline Of Unresponsiveness
EYE RESPONSE
4 = Eyelids open, tracking or blinking to command.
3 = Eyelids open but not tracking.
2 = Eyelids closed but open to loud voice.
1 = Eyelids closed but open to pain.
0 = Eyelids remain closed to pain.
MOTOR RESPONSE
4 = Thumbs up, fist, or peace sign.
3 = Localizing to pain.
2 = Flexion response to pain.
1 = Extension response.
0 = No response to pain, or general myoclonus status.
BRAIN STEM REFLEXES
4 = Pupil and corneal reflexes present.
3 = One pupil wide and fixed.
2 = Pupil or corneal reflexes absent.
1 = Pupil and corneal reflexes absent.
0 = Pupil, corneal, and cough reflexes absent.
RESPIRATION
4 = Not intubated, regular breathing pattern.
3 = Not intubated, Cheyne-Stokes breathing pattern.
2 = Not intubated, irregular breathing.
1 = Breathes above ventilator rate.
0 = Breathes at ventilator rate or with apnea.
Source: Dr. Wijdicks
To receive a copy of the FOUR pocket instructional card, e-mail Dr. Wijdicks at