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Neurologists at the Mayo Clinic have created an easy and reliable method for measuring coma depth. Called the FOUR (Full Outline of UnResponsiveness) Score, the new test is a proposed replacement for the Glasgow Coma Scale.


To use the FOUR Score system, evaluators assign a score of zero to four in each of four categories: eye, motor, brain stem, and respiratory function. A score of zero represents no function. A score of four indicates normal function.


The new method's inventor, neurologist Eelco Wijdicks, MD, said the Glasgow Coma Scale misses key elements of a neurologic exam of comatose patients. He says the new scoring system is simple yet more comprehensive, and that anyone on the health care team can use it reliably.


Putting the FOUR score to the test, Dr. Wijdicks applied it to 120 comatose patients in intensive care units. He compared his scores with those obtained by neuroscience nurses and neurology residents using the Glasgow Coma Scale. He found that the FOUR score had these advantages over the Glasgow system:


* Comatose patients were fully testable, even with an endotracheal tube.


* Brain stem reflexes that indicate the entire brain's health could be tested, providing information for immediate intervention and prognosis.


* The test identified locked-in syndrome.


* Test scores correlated better with patient outcomes.