FOUR Score (Full Outline of UnResponsiveness)

When it activates

Scribeable activates a calculator from the encounter. The FOUR Score (Full Outline of UnResponsiveness) can activate when the transcript or pasted chart context documents any of these:

• Coma assessment in intubated patient
• Detailed neurological assessment in obtunded patient
• Brainstem function evaluation
• ICU neurological monitoring
• Prognostication in comatose patient

Note-type scope: it activates on notes whose subject resolves to neurology, critical care, emergency medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

4 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

4 components each scored 0-4: Eye + Motor + Brainstem + Respiration. Total range 0-16.

Interpretation

FOUR 0: Possible brain death — evaluate for brain death testing. FOUR 1-6: Severe impairment, poor prognosis. FOUR 7-12: Moderate impairment. FOUR 13-16: Mild impairment or normal. Advantage over GCS: can assess intubated patients, tests brainstem reflexes, detects locked-in syndrome.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Wijdicks EFM et al. 2005.

• Wijdicks EF et al. Validation of a new coma scale: the FOUR scoreWijdicks et al. (FOUR Score) 2005 · 2005 · Mayo Clinic · Level I · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the FOUR Score (Full Outline of UnResponsiveness) (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a FOUR Score (Full Outline of UnResponsiveness) value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.

Related calculators

• Canadian CT Head RuleDetermines need for CT head in patients with minor head injury (GCS 13-15) to identify clinically important brain injury
• Fisher GradeClassifies SAH severity on CT to predict risk of cerebral vasospasm
• Glasgow Coma Scale (GCS)Assesses impaired consciousness and coma severity
• Hunt-Hess ScaleGrades clinical severity of subarachnoid hemorrhage to predict outcome and guide management
• NIH Stroke Scale (NIHSS)Quantifies stroke severity and monitors neurological changes
• ABCD2 ScoreEstimates short-term stroke risk after TIA

Can activate in: Emergency Medicine, Neurology, Neurosurgery, Critical Care / ICU.