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Scoring methodology to assess physical well being of chronically ill patients
Dr. T. Balasubramanian M.S. D.L.O.
It is very difficult to assess the physical well being of chronically ill patients. Chronic illness in this context indicates a chronic ailment with which a patient has to suffer right through his / her life. These illnesses include Malignancies, chronic renal disorders, CNS disorders etc.
Advantages of these scoring systems:
1. It attempts to assess the sense of physical well being of patients.
2. Assesses the adequacy / usefulness of the treatment modality.
3. Helps in the adjusment of drug dosage in chemotherapy.
4. Helps in the assessment of required intensity of palliative care.
Available scoring systems:
There are various scoring systems available. They include:
1. Karnofsky score
2. Zubrod score - This score is commonly used in WHO publications
3. Lansky score - This score is used commonly in children
4. Global assessment of functioning (GAF) score - This method of scoring is used in psychiatry
Karnofsky scoring system: This scoring system is named after Dr David A. Karnofsky, who described the scale with Dr Joseph H. Burchenal in 1949.
This score infact runs from 100 - 0. A score of 100 means perfect health, while a score of 0 means death.
100 - Perfect health
90 - Capable of normal activity, few symptoms or signs of disease
80 - Normal activity with some difficulty, some symptoms or signs
70 - Caring for self, not capable of normal activity or work
60 - Requiring some help, can take care of most personal requirements
50 - Requires help often, requires frequent medical care
40 - Disabled, requires special care and help
30 - Severely disabled, hospital admission indicated but no risk of death
20 - Very ill, urgently requiring admission, requires supportive measures or treatment
10 - Moribund, rapidly progressive fatal disease processes
0 - Death
Zubrod score: Also known as WHO score. Was first published by Oken et al in 1982. This score runs from 0 - 5. 0 indicates perfect health, while 5 denotes death.
0 - Normal health
1 - Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
2 - Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
3 - Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)
4 - Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)
5 - Death
Lansky score: This scoring pattern is very useful in assessing the well being of children. They infact present unique problems in the scoring system. This system of scoring was proposed by Lansky etal in 1987. This scoring pattern starts with 100 which is normal for a child, with 0 indicating an unresponsive child.
100 - Fully active, normal
90 - Minor restrictions in strenuous physical activity
80 - Active, but tired more quickly
70 - Greater restriction of play and less time spent in play activity
60 - Up and around, but active play minimal; keeps busy by being involved in quieter activities
50 - Lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities
40 - Mainly in bed; participates in quiet activities
30 - Bedbound; needing assistance even for quiet play
20 - Sleeping often; play entirely limited to very passive activities
10 - Doesn't play; does not get out of bed
0 - Unresponsive