Medical Scores – G
GRAVES ORBITOPATHY:
- Activity is easily measured by the clinical activity score (CAS). A CAS ≥3/7 is indicative of active GO. Severity is rated as mild, moderate to severe and sight threatening (or very severe)
- Graves’ orbitopathy activity assessment according to CAS
-
- 1 Spontaneous retrobulbar pain
- 2 Pain on attempted upward or downward gaze
- 3 Redness of eyelids
- 4 Redness of conjunctiva
- 5 Swelling of caruncle or plica
- 6 Swelling of eyelids
- 7 Swelling of conjunctiva (chemosis)
- Inactive GO=CAS<3
- Active GO=CAS≥3
- CAS – Clinical activity score, GO – Graves’ orbitopathy, DON – Dysthyroid optic neuropathy.
GLASGOW COMA SCALE:
- For use in trauma patients with decreased LOC; good indicator of severity of injury and neurosurgical prognosis
- Most useful if repeated; change in GCS with time is more relevant than the absolute number
- Less meaningful for metabolic coma
- Patient with deteriorating GCS needs immediate attention
- Prognosis based on best post-resuscitation GCS
- Reported as a 3-part score: Eyes + Verbal + Motor = Total
- If patient intubated, GCS score reported out of 10 + T (T = tubed, i.e. No verbal component)
TABLE 3. GLASGOW COMA SCALE:
| Eyes Open | Best Verbal Response | Best Motor Response | |||
| Spontaneously | 4 | Answers questions appropriately | 5 | Obeys commands | 6 |
| To voice | 3 | Confused, disoriented | 4 | Localizes to pain | 5 |
| To pain | 2 | Inappropriate words | 3 | Withdraws from pain | 4 |
| No response | 1 | Incomprehensible sounds | 2 | Decorticate (flexion) | 3 |
| No verbal response | 1 | Decerebrate (extension) | 2 | ||
| No response | 1 |
13-15 = mild injury, 9-12 = moderate injury, ≤8 = severe injury
MODIFIED GLASGOW COMA SCORE:
Modified GCS
| Modified GCS for Infants | |||||
| Eye Opening | Verbal Response | Motor Response | |||
| Spontaneously | 4 | Coos, babbles | 5 | Normal, spontaneous movement | 6 |
| To speech | 3 | Irritable cry | 4 | Withdraws to touch | 5 |
| To pain | 2 | Cries to pain | 3 | Withdraws to pain | 4 |
| No response | 1 | Moans to pain | 2 | Decorticate flexion | 3 |
| No response | 1 | Decerebrate extension | 2 | ||
| No response | 1 | ||||
| Modified GCS for Children <4 years | |||||
| Eye Opening | Verbal Response | Motor Response | |||
| Spontaneously | 4 | Oriented, social, speaks, interacts | 5 | Normal, spontaneous movement | 6 |
| To speech | 3 | Confused speech, disoriented, consolable | 4 | Withdraws to touch | 5 |
| To pain | 2 | Inappropriate words, not consolable / aware | 3 | Withdraws to pain | 4 |
| No response | 1 | Incomprehensible, agitated, restless, not aware | 2 | Decorticate flexion | 3 |
| No response | 1 | Decerebrate extension | 2 | ||
| No response | 1 | ||||
MODIFIED CENTOR SCORE: APPROACH TO DIAGNOSIS AND MANAGEMENT OF GABHS:
| POINTS | |
| Cough absent? | 1 |
| History of fever >38ºC? | 1 |
| Tonsillar exudate? | 1 |
| Swollen, tender anterior nodes? | 1 |
| Age 3-14 | 1 |
| Age 15-44 | 0 |
| Age >45 | -1 |
IN COMMUNITIES WITH MODERATE LEVELS OF STREP INFECTION (10-20% OF SORE THROATS):
| Score | 0 | 1 | 2 | 3 | 4 or More |
| Chance patient has strep | 1-2.5% | 5-10% | 11-17% | 28-35% | 51-53% |
| Suggested action | NO culture or antibiotic | Culture all, treat with antibiotics only if culture is positive | Culture all, treat with antibiotics on clinical grounds1, discontinue antibiotics if culture comes back negative | ||
Clinical grounds include a high fever or other indicators that the patient is clinically unwell and is presenting early in the course of the illness Limitations:
*This score is not applicable to patients <3 yr of age.
*If an outbreak or epidemic of illness caused by GABHS is occurring in any community, the score is invalid and should not be used
WHO PROGNOSTIC SCORE FOR GTD (2011):
| Score | ||||
| Prognostic Factor | 0 | 1 | 2 | 4 |
| Maternal Age | >40 | 40 | ||
| Antecedent Pregnancy | Mole | Abortion | Term | |
| Interval (End of Antecedent Pregnancy to Chemotherapy in Months) | <4 | 4-6 | 7-13 | >13 |
| HCG IU/1 | <103 | 103-104 | 104-105 | >105 |
| Number of Metastases | 0 | 1-4 | 5-8 | >8 |
| Site of Metastases | Lung | Spleen, kidney | GI tract | Brain, liver |
| Largest Tumour Mass | 3-5 cm | >5 cm | ||
| Prior Chemotherapy | Single drug | Two drug | ||
GLEASON SCORE FOR PROSTATE CANCER:
- Grade 1 – Small uniform glands
- Grade 2- More space between glands and increase in stroma
- Grade 3- Distinct infiltration of cell margin
- Grade 4- Irregular masses of neoplastic cells
- Grade 5 – Lack of glandular pattern
- Old score- grade 1(well differentiated)-grade 5(poorly differentiated)
- New Gleason score: Extends from grade 1 to grade 10
