8/31/2023 0 Comments Glasgow coma scale score sheetThe 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. ![]() 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?
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