Evaluating impaired consciousness in the clinical and surgical intensive care unit (ICU) is challenging. The eye response, motor response, brainstem reflexes, and respiration pattern (FOUR) score and Glasgow coma scale (GCS) score are two standard scoring systems for uniform, quantitative, and objective assessment of the severity of illness and predicting outcomes in neurocritical care. It is not clear which score has better calibration and discrimination power in predicting critical patients' outcomes. The debate has different implications for children as scoring systems face unique challenges when they are used for critically ill children. The GCS has been regularly utilized in neurosurgical ICUs, but its dependability in predicting patient outcomes is continuously debated.[1] The FOUR score is an indicator of the prognosis of fundamentally sick patients which has significant favorable circumstances.[2] [3] The FOUR score depends on the absolute minimum of tests essential for evaluating a patient with altered consciousness by incorporating many essential data that is not surveyed by the GCS or other scales. It includes the estimation of brainstem reflexes, determination of eye-opening, a broad spectrum of motor responses, and the presence of anomalous breath rhythms and a respiratory drive.[4]