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