The FOUR Score further characterizes the severity of the comatose state in patients with the lowest GCS scores of 3-4. Attention to respiratory patterns in the FOUR Score may not only indicate a need for intubation in comatose patients, but also provides information about the presence of a respiratory drive.

The FOUR Score includes signs suggesting brain herniation. The FOUR Score recognizes a locked-in syndrome and a possible vegetative state.

The FOUR Score tests crucial brainstem reflexes and provides information about the severity of brainstem injury which are unavailable with the GCS. What pearls, pitfalls and/or tips do you have for users of the FOUR Score? Do you know of cases when it has been applied, interpreted, or used inappropriately? The FOUR Score is easy to use and has been validated in numerous studies in numerous countries, and is rapidly becoming the most validated scale in neurology. When communicating the GCS, I always felt I remained uninformed and also noted poor use of its individual components with many physicians resorting to a handy sum score (i.e., GCS 3, GCS 8, GCS 14). The main reason to develop the FOUR Score was the major shortcomings of the Glasgow Coma Scale. Lancet 1974,2:81-84.Ģ) The Glasgow Structured Approach to Assessment of the GLASGOW COMA SCALE.Why did you develop the FOUR Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians? Assessment of coma and impaired consciousness. ■ Minor brain injury – results in temporary or permanent neurological effects, in some cases with no imagistic (CT scan, MRI) clear evidence of the brain damage. ■ Moderate brain injury – results in long term cognitive and physical impairment with the changes appearing shown in CT scans or MRIs. ■ Severe brain injury – results in long term cognitive, physical impairment accompanied by emotional, behavioral changes, diagnosed through imagistic means and GCS. The highest score, with the highest level of consciousness is 15. The lowest score for each category is 1, therefore the overall lowest is 3 with no eye opening, no verbalization and no response to pain stimuli. Eye opening has a maximum of 4 points, verbal response totalizes a maximum of 5 points while motor response has a maximum of 6 points. GCS InterpretationĪs explained above, there are three types of response that are assessed, each with its own choices and a scoring system with points. However, it is often underlined that this should not be used as a quantitative method, on its own as a mean to monitor brain injury. GCS is not only a tool to assess and score mental status but can also offer clinical support in certain decisions such as a GCS of 8 or below might require intubation. It is recommended to be used repetitively to chart changes in mental status and duration of coma. It is very important to follow the patient trend through frequent observations because then the correlation with outcome and severity increases. This method is used by clinicians and medical staff in ER (emergency rooms) and ICU (intensive care units) in both trauma and non trauma presentations. If the state deteriorates, the half hourly observation should be re- established. Once this value is achieved, the observations should be taken half hourly in the first 2 hours, 1 per hour for the following 4 hours and then 2 hourly. Observations are to be recorded every half hour until GCS reaches 15. This Glasgow coma scale calculator is used both as a method to assess the current state and to predict the progression of the condition because observations are to be taken and registered at certain time intervals. Inappropriate words with the patient saying words but not sentencesĬonscious obeying of the motor commands given Oriented responses with the patient being coherent and answering appropriatelyĬonfused answering with the patient disoriented There are three types of response that are monitored: Glasgow Coma Scale (GCS)Įye opening to auditive stimulus e.g. Jennett, professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences in 1974 and is now universally established as a way of observing and quantifying the conscious state of someone who suffers from brain injury. This is a method published by Graham Teasdale and Bryan J. The Glasgow coma scale/score GCS Calculator

Glasgow coma scale score sheet