FOUR score

Compute the FOUR score as the sum of caller-assigned eye, motor, brainstem, and respiration integers 0-4.

LIVE $0.005 USDC GET /api/calc/four_score

Markdown: /docs/four-score.md · Canonical: https://magentlab.com/docs/four-score

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Compute the FOUR score as the sum of caller-assigned eye, motor, brainstem, and respiration integers 0-4.

When to use

When an agent has already assigned the Wijdicks 2005 FOUR component integers (0-4) and needs the published total, not a GCS conversion or a narrative-to-score mapping.

When not to use

Not a diagnosis and not a trauma triage, intubation, or disposition order.
Eye, motor, brainstem, and respiration are caller-supplied integers 0-4. magent does not observe the four signs and does not pick a component from a narrative.
Total is 0-16. magent does not add outcome bands beyond that published range.

Formula

FOUR = eye + motor + brainstem + respiration; each caller-assigned integer 0-4; max 16

Citation

Title: Validation of a new coma scale: The FOUR score
Authors: Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL
Source: Ann Neurol. 2005;58(4):585-593
DOI: 10.1002/ana.20611

Worked example

E4 M4 B4 R4

Given: brainstem=4eye=4motor=4respiration=4

eye 4 + motor 4 + brainstem 4 + respiration 4
Score = 16 (max 16)

E0 M0 B0 R0

Given: brainstem=0eye=0motor=0respiration=0

eye 0 + motor 0 + brainstem 0 + respiration 0
Score = 0 (max 16)

Also searched as

FOUR score
Full Outline of UnResponsiveness
Wijdicks FOUR
FOUR coma scale
eye motor brainstem respiration
Wijdicks 2005 FOUR
Full Outline of UnResponsiveness score

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/four_score?eye=4&motor=4&brainstem=4&respiration=4

Full URL: https://api.magentlab.com/api/calc/four_score?eye=4&motor=4&brainstem=4&respiration=4

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/four_score?eye=4&motor=4&brainstem=4&respiration=4"

Parameters

Name	Type	Required	Description
`eye`	integer	required	Caller-assigned Wijdicks 2005 eye points (integer 0-4). magent does not pick the component from a narrative. 4 tracking or blink to command; 3 open not tracking; 2 open to voice; 1 open to pain; 0 closed to pain.
`motor`	integer	required	Caller-assigned Wijdicks 2005 motor points (integer 0-4). magent does not pick the component from a narrative. 4 thumbs-up, fist, or peace to command; 3 localizing; 2 flexion; 1 extension; 0 none or myoclonus status.
`brainstem`	integer	required	Caller-assigned Wijdicks 2005 brainstem points (integer 0-4). magent does not pick the component from a narrative. 4 pupil and corneal present; 3 one pupil wide and fixed; 2 pupil or corneal absent; 1 pupil and corneal absent; 0 pupil, corneal, and cough absent.
`respiration`	integer	required	Caller-assigned Wijdicks 2005 respiration points (integer 0-4). magent does not pick the component from a narrative. 4 not intubated regular; 3 Cheyne-Stokes; 2 irregular; 1 breathes above ventilator; 0 ventilator rate or apnea.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/four_score Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "brainstem": "4",
      "eye": "4",
      "motor": "4",
      "respiration": "4"
    },
    {
      "brainstem": "4",
      "eye": "4",
      "motor": "4",
      "respiration": "4"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/four_score",
  "items": [
    {
      "components": [
        {
          "value": 4,
          "factor": "eye",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "motor",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "brainstem",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "respiration",
          "points": 4,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL",
        "doi": "10.1002/ana.20611",
        "id": "wijdicks-2005",
        "pmid": "16178024",
        "source": "Ann Neurol. 2005;58(4):585-593",
        "title": "Validation of a new coma scale: The FOUR score"
      },
      "formula": "four_score",
      "formula_expression": "FOUR = eye + motor + brainstem + respiration; each caller-assigned integer 0-4; max 16",
      "max_score": 16,
      "score": 16
    },
    {
      "components": [
        {
          "value": 4,
          "factor": "eye",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "motor",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "brainstem",
          "points": 4,
          "present": true
        },
        {
          "value": 4,
          "factor": "respiration",
          "points": 4,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL",
        "doi": "10.1002/ana.20611",
        "id": "wijdicks-2005",
        "pmid": "16178024",
        "source": "Ann Neurol. 2005;58(4):585-593",
        "title": "Validation of a new coma scale: The FOUR score"
      },
      "formula": "four_score",
      "formula_expression": "FOUR = eye + motor + brainstem + respiration; each caller-assigned integer 0-4; max 16",
      "max_score": 16,
      "score": 16
    }
  ]
}

Response

Field	Type	Description
`formula`	string	four_score
`formula_expression`	string	Exact expression used
`score`	integer	Total points 0-16
`max_score`	integer	Always 16
`components`	array	Per-sign 0-4 points
`citation`	object	Wijdicks 2005 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "value": 4,
      "factor": "eye",
      "points": 4,
      "present": true
    },
    {
      "value": 4,
      "factor": "motor",
      "points": 4,
      "present": true
    },
    {
      "value": 4,
      "factor": "brainstem",
      "points": 4,
      "present": true
    },
    {
      "value": 4,
      "factor": "respiration",
      "points": 4,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL",
    "doi": "10.1002/ana.20611",
    "id": "wijdicks-2005",
    "pmid": "16178024",
    "source": "Ann Neurol. 2005;58(4):585-593",
    "title": "Validation of a new coma scale: The FOUR score"
  },
  "formula": "four_score",
  "formula_expression": "FOUR = eye + motor + brainstem + respiration; each caller-assigned integer 0-4; max 16",
  "max_score": 16,
  "score": 16
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_four_component`	eye, motor, brainstem, and respiration must each be an integer from 0 to 4 (Wijdicks 2005). Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

Glasgow Coma Scale — Compute the Glasgow Coma Scale as the sum of caller-assigned eye, verbal, and motor integers. The 1974 or 1976 edition is required.
Hunt-Hess — Return the Hunt and Hess 1968 subarachnoid-hemorrhage surgical-risk grade from a caller-assigned grade 1-5, applying the paper's next-less-favorable bump when serious systemic disease is present.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.