# FOUR score

FOUR score

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/four_score`
HTML: https://magentlab.com/docs/four-score
Markdown: https://magentlab.com/docs/four-score.md

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

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

## Worked example

### E4 M4 B4 R4

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

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


### E0 M0 B0 R0

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

1. eye 0 + motor 0 + brainstem 0 + respiration 0
2. 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

## Parameters

- `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.

Method: `POST /api/calc/four_score`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: 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:

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

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/four-score

Example 200:

```json
{
  "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 fields

- `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

Frozen fixture. Not a live lookup.

```json
{
  "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
}
```

## Errors

- HTTP 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.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Glasgow Coma Scale](https://magentlab.com/docs/gcs) — 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](https://magentlab.com/docs/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.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON echoing accepted, payload, and extensions when present).
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/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.