Tested on Gulf Medical Boards (DHA, SMLE, MOH & HAAD)
Clinical calculations and diagnostic scoring systems like FOUR Score frequently appear on Prometric exams. Master high-yield clinical vignettes with instant AI-powered pathophysiology rationales.
What is the FOUR Score?
The FOUR Score is an evidence-based clinical decision rule engineered to quantify diagnostic probability, stratify clinical severity, and guide therapeutic decision-making in neurology practice. The Full Outline of UnResponsiveness (FOUR) Score is a clinical grading scale designed to assess patients with impaired level of consciousness. It includes brainstem reflexes and respiration, making it particularly useful in intubated patients where the verbal component of the GCS cannot be tested. Clinical scoring tools like FOUR Score are essential in acute and outpatient management, enabling clinicians to objectively differentiate between low-risk candidates suitable for conservative therapy and high-risk patients requiring urgent interventions. Verified against current 2026 clinical standards, this tool is extensively tested on Gulf health authority licensing exams including DHA (Dubai), SMLE (Saudi Arabia), MOH, HAAD/DOH (Abu Dhabi), OMSB (Oman), and QCHP (Qatar).
💡Clinical Pearls & Diagnostic Utility
Captures brainstem reflexes and breathing patterns not evaluated in the GCS. It provides greater neurological detail, especially in patients intubated for airway protection.
Formula & Calculation Parameters
The mathematical equation and clinical variables required to calculate FOUR Score:
Score Interpretation & Clinical Stratification
| Score Range | Clinical Interpretation | Risk Tier |
|---|---|---|
| ≤ 7 | Severe Coma | red |
| 8 – 12 | Moderate Impairment | yellow |
| ≥ 13 | Mild/No Impairment | green |
When to Exercise Caution
May be more complex for novice providers to learn and perform compared to the universally recognized GCS.
Clinical Review Board
Dr. Muhammad Nouman, MBBS
Capital Medical University | PMDC Reg No: 117744-P
Clinical Audit Status
✓ Verified for 2026 Guidelines
Last updated: 2026-08-07
Peer-Reviewed Medical Literature
- •Wijdicks EF, Bamlet WR, Maramattom BV, et al. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58(4):585-593.
Related Neurology Calculators & Scoring Tools
Explore related clinical calculators, risk stratification indexes, and diagnostic scoring algorithms in Neurology:
Wells' Criteria for DVT
Calculates the pre-test probability of Deep Vein Thrombosis.
Glasgow Coma Scale (GCS)
Assesses the level of consciousness after neurological injury.
qSOFA Score
Quick Sequential Organ Failure Assessment for sepsis risk.
Centor Score
Estimates probability of streptococcal pharyngitis.
Mean Arterial Pressure (MAP)
Calculate MAP based on Systolic and Diastolic Blood Pressure.
CURB-65 Score for Pneumonia
Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.