FOUR (Full Outline of UnResponsiveness) Score

Clinical management decisions should not be based solely on the FOUR Score in the acute setting and should be used in conjunction with other clinical information.

Very low FOUR scores (≤4) are more predictive of in-hospital mortality as compared to the lowest GCS (3T).

Improvement in score of >2 is predictive of survival in cardiac arrest (Fugate 2010).

Each point increase in the FOUR Score is associated with decreased mortality and morbidity.

Abnormalities or decline in score should prompt reassessment and further evaluation for intracranial pathology.

While the FOUR Score may help suggest specific states of impaired consciousness, it is important to clearly identify the clinical criteria prior to making these diagnoses.