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FOUR Score Coma Scale Calculator

Score each of the four components from 0 to 4 to get the total FOUR Score.

How it is calculated

The total is simply the sum of four sub-scores: FOUR = eye + motor + brainstem + respiration, each component graded from 0 (worst) to 4 (best), so the total runs from 0 to 16 and a higher number means a more responsive patient. The tool does not decide the grades for you. You assess the patient against the published description of each level and enter the four numbers. Each entry is rounded to a whole number and anything below 0 or above 4 is silently set to 0 or 4, so a typo is corrected without a warning. All four fields must be filled in. The result is shown as a total out of 16 and carries no interpretation or diagnosis.

Worked example

A patient is graded eye 3, motor 2, brainstem 4 and respiration 3. Add the four components: 3 + 2 = 5, then 5 + 4 = 9, then 9 + 3 = 12. The tool shows 12 / 16. If at the next bedside check the motor grade drops from 2 to 1 while the others stay the same, the total falls to 11 / 16, which is how repeated scoring is used to follow a trend. Each component also matters on its own, so record the four numbers and not just the total.

Try this example →

Common mistakes

  • Relying on the total alone. Two patients can both score 8 / 16 with very different patterns, such as a zero brainstem score versus a zero motor score, so the individual components carry the information.
  • Entering a value above 4 or below 0 and trusting it. The tool silently clamps it to 4 or 0, so a mistyped 5 is counted as 4 without a warning.
  • Entering a decimal such as 2.5 for an uncertain grade. The tool rounds it to a whole number, and the scale only has whole grades, so decide between the two levels instead.
  • Using the tool as a replacement for a bedside examination. It adds up grades you have already assigned; it does not examine the patient or interpret the result.

Sources

About this calculator

The FOUR Score (Full Outline of UnResponsiveness) is a neurological consciousness scale developed to assess severely impaired patients more precisely than the Glasgow Coma Scale, particularly when a patient is intubated and cannot produce a verbal response. It rates four components — eye response, motor response, brainstem reflexes, and respiration pattern — each from 0 to 4, for a combined total of 0 to 16.

Because it captures brainstem reflexes (pupillary, corneal, cough) and ventilator status directly, the FOUR Score can distinguish conditions like locked-in syndrome or brain death patterns that a verbal-dependent scale would miss. Neurologists, neurosurgeons, and neuro-ICU nurses use it serially at the bedside to track a comatose or critically ill patient's trajectory and detect deterioration early.

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