Different Scales Used In Different Systems In Body

DIFFERENT SCALES USED IN TRANSCRIPTION

1.  PSYCHIATRY

       APGAR questionnaire:

          Adaptability, Partnership, Growth, Affection, Resolve – Arabic numerals

      Global Assessment of Functioning (GAF) scale:

         AXIS plus Roman numerals I to V.

      Global Assessment of Relational Functioning (GARF) scale:

        GARF plus Arabic numerals from 0 to 100.

       Social and Occupational Functioning Assessment scale (SOFAS):

         SOFAS plus Arabic numerals from 0 through 100.

2.  OB/GYN:

Apgar score:  (Named after Virginia Apgar, MD - Pediatrics)

         Arabic numerals    Example – Apgars 7 and 9 at one and five minutes

3.  CANCER CLASSIFICATIONS:  stage, grade, class

      Lowercase stage and grade.

      Cancer stage – Use Roman numerals      stage I, stage II, stage III etc.   stage IA, stage IIB etc.

      Cancer grades – Use Arabic numerals – grade 1, grade 2, grade 3 etc.

      Aster-Coller:  (Staging system for colon cancer)

        Lowercase stage with Capital A to D.

      Broders index:  (Classification of aggressiveness of tumor malignancy)

       Lowercase grade and use Arabic numerals 1 through 4.  Ex. – Broders grade 3.

     Cervical Cytology:  Uses.

        Pap smear – class I through class V

       CIN classification system – Arabic numerals from grade 1 to grade 3.  Place a hyphen between CIN and the numeral.  Example – CIN-1 or CIN grade 1; CIN-2 or CIN grade 2; CIN-3 or CIN grade 3 etc.

       Bethesda system – combination of Pap and CIN

     Clark level:  (Primary malignant melanoma of the skin from the epidermis)

      Lower case level and Roman numerals I to IV.  Example – Clark level II

      Dukes classification:  (named after British pathologist Cuthbert E. Dukes - Adenocarcinoma of the colon or rectum)

      Example – Dukes A; Dukes B; Dukes C.

      If further defined by numbers, then Dukes C2 etc.

      FAB classification:  (French-American-British morphologic classification system for acute nonlymphoid leukemia)

      Express with capital M followed by Arabic numeral 1 through 6.  No space between M and number.

      Example – M1, M2, M3, M4, M5, M6

      FIGO staging:  (Federation Internationale de Gynecologie et Obstetrique system)

       For staging gynecologic malignancy, particularly carcinomas of the ovary.

       Expressed with lowercase stage and Roman numerals.

        Examples – stage I through stage IV……subdivisions as “a, b, c”

        FIGO stage IIc

      Gleason tumor grade/score:  (Adenocarcinoma of the prostate)

       Lower case grade/score and use Arabic numerals.

Example – Gleason 3 + 2 with a total score of 5 / Gleason score 3 + 2 = 5.

      Jewett classification:  (Bladder carcinoma)

      Lower case class with capitals – Example – Jewett class O(not zero), A, B, C, D.

         Bladder carcinoma, Jewett class B.

       Karnofsky rating scale/status:  (Rating performance status of malignant neoplasms)

       Use Arabic numerals: 10, 20, 30, 40, 50, 60, 70, 80, 90, 100 (Normal is 100 and moribund is 10)

       TNM staging system:  (For malignant tumors)

       Write TNM expressions with Arabic numerals on the line and a space after each number.

       Example:  T2 N1 M1…..T4 N3 M1

4.  CARDIOLOGY:

      Leads:

       Leads – Roman numerals.  Example – lead I, lead II, lead III.

       Precordial leads – Capital V with Arabic numerals and no space in between.  Example – V1, V2, V3 to V9.

      NYHA classification of cardiac failure:

      Lower case class and Roman numerals I through IV.  Ex. – Cardiac failure, class III.

      TIMI system:  (Coronary artery angiography - Thrombolysis in myocardial infarction)

       Lower case grade and Arabic numerals.  Ex. – TIMI grade 3 flow

      QRS axis:  Use a plus or minus sign followed by Arabic numerals and a degree sign to express the number of degrees, or write out degrees.

       Example:  QRS +60 degrees

      Angina:  Lowercase class and Roman numerals.

        Unstable angina - I through III, subclass A, B, C.  Ex. – Braunwald class I or IA

        Exertional angina – CCS system used I through IV. Ex – CCS class I

      Myocardial infarction:  Two classification systems to assess function & status after.

       Cardiac function:  Forrester classification plus lowercase class and Roman numerals.

                 Example – Forrester class I through IV.

       Cardiac status  Killip classification plus lowercase class and Roman numerals.

                 Example – Killip class I through IV

      CHADS / CHADS2 score:  (For atrial fibrillation stroke risk)

       Example:  CHADS2 score of 5

Canadian Cardiovascular Society grading of Angina Pectoris (CCS Angina Grading Scale or the CCS Functional Classification of Angina:

Lower case class and Roman numerals 0 through IV.

• Class I – Angina only during strenuous or prolonged physical activity
• Class II – Slight limitation, with angina only during vigorous physical activity
• Class III – Symptoms with everyday living activities, i.e., moderate limitation
• Class IV – Inability to perform any activity without angina or angina at rest, i.e., severe limitation

Class 0 has also been proposed as an asymptomatic category.

5.  NEUROLOGY:

       Glasgow coma scale:  (Describes level of consciousness of patients with head injuries)

          Numbers from 0 to 15

       Hunt and Hess neurological classification: (Classifies prognosis of patients with hemorrhage)

         Lowercase grade with Arabic numerals 1 through 5.

         Example – Hunt and Hess grade 1

       Kurtzke Expanded Debility Status Scale (EDSS): (To evaluate patients with multiple sclerosis)

          Example – Disability Status Scale 0 to 10

       Rancho Los Amigos Cognitive Function Scale:

        Use level with Roman numerals.  Example

       Epworth Sleepiness Scale:  (Measures daytime sleepiness)

        Arabic numerals 1 to 24.  Example – Epworth Sleepiness Scale is 16

6.  ORTHOPEDICS:

      Catterall hip score:  (Rating system for Legg-Perthes disease)

         Lowercase grade and Roman numerals I through IV

      Crowe classification:  (System for classifying developmental dysplasia of hip)

         Lowercase grade and Roman numerals I through IV.

      Tonnis classification of osteoarthritis by radiographic changes of femoral head:

        Lowercase grade and Arabic numerals from 0 through 3.

      Outerbridge scale:  (To assess damage in chondromalacia patellae)

        Lowercase grade and Arabic numerals 1 through 4.

        Example – Chondromalacia patellae, grade 3.

 

      Medial collateral ligament injury grading - Injuries of the medial collateral ligament (MCL) are graded into three groups on MRI, much in the same way as many other ligaments.

• grade 1: (minor sprain) high signal is seen medial (superficial) to the ligament, which looks normal
• grade 2: (severe sprain or partial tear) high signal is seen medial to the ligament, with high signal or partial disruption of the ligament

·                                 grade 3: complete disruption of the ligament

As a general rule, the MCL is not repaired in the general population, if it is an isolated injury. In athletes, grade 3 injuries often require surgical correction.  After a few weeks it may appear as a Pellegrini-Stieda syndrome or a Pellegrini-Stieda (PS) lesion, a post-traumatic/post-avulsion calcification of the proximal medial collateral ligament.

   Fracture Classification Systems:

      Garden:  (Subcapital fractures of femoral neck)

       Lowercase stage and use Arabic numerals – Stage 1 through stage 3.

      LeFort:  (Classification of facial fractures)

       Use Roman numerals I, II, III.  Ex. – LeFort I.

      Mayo:  (Classification of olecranon fractures)

       Lowercase “type” and use Roman numerals and capital letters.

        type I; type IA; type IB

        type II; type IIA; type IIB

        type III; type IIIA; type IIIB

      Neer staging:  (System for classifying shoulder impingement)

       Lowercase stage with Roman numerals I through III.

      Neer-Horowitz:  (Classification for proximal humeral physeal fractures in children)

       Use Roman numerals I through IV.  Example – Neer-Horowitz II

      Salter:  (Classification of epiphyseal fractures)

       Use Roman numerals I through VI.  Example – Salter III fracture

      Salter-Harris:  (Fracture involving the physis of children)

       Use Roman numerals I through V.  Example – Salter-Harris fracture type II.

      Schatzker:  (Classification of tibial plateau fractures)

       Lowercase “type” and use Roman numerals I through VI

       Example – Schatzker type III

      Stress fractures:  Lowercase grade and Roman numerals I through IV.

7.  Burns classification:

        Burns described as 1^st, 2^nd, 3^rd, and 4^th degree according to burn depth.

          Express in ordinals preferred to writing them out.

            Example – 1^st degree burn; 2^nd degree burn etc.

8.  Decubitus ulcers:

        Use lowercase stage and Roman numerals.

         Example – Decubitus ulcer stage III

9.  GVHD grading system (graft-versus-host-disease):

        Arabic numerals 1 through 4

         Example – GVHD1; GVHD2 etc.

10.  Mallampati-Samsoon classification of airway:

      Lowercase class plus Roman numerals

11.  Trauma score:  Use Arabic numerals 2 through 16..

12.  Clotting Factors:  Lower case factor and use Roman numerals.

     Example – factor I, factor II, factor III, etc….

13.  Platelet Factors:  Abbreviation is PF and use Arabic numerals with a space in between PF and number.

       Example – PF 3..etc

KIDNEY STAGING – In Arabic numerals.

OBESITY:  Lower case class and Roman numerals I, II, and III.

ESOPHAGITIS GRADING SCALES USED:

Savary-Miller

Grade I: one or more supravestibular, non-confluent reddish spots, with or without exudate.
Grade II: erosive and exudative lesions in the distal esophagus which may be confluent, but not
Grade III: circumferential erosions in the distal esophagus, covered by hemorrhagic and pseudomembranous exudates.
Grade IV: presence of chronic complications such as deep ulcers, stenosis, or scarring with Barrett’s metaplasia.

Modified Hetzel-Dent

Grade 0: Normal mucosa, no abnormalities found
Grade 1: No macroscopic erosions, but presence of erythema, hyperemia, and/or friability of the esophageal mucosa.
Grade 2: Superficial ulceration or erosions involving less than 10% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.
Grade 3: Superficial ulceration or erosions involving greater than or equal to 10% but less than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.
Grade 4: Deep ulceraton anywhere in the esophagus or confluent erosion of more than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.
Grade 5: Stricture, defined as a narrowing of the esophagus that does not allow easy passage of the endoscope without dilation.

Los Angeles Classification

Not present: No breaks (erosions) in the esophageal mucosa (edema, erythema, or friability may be present)
Grade A: One or more mucosal breaks confined to the mucosal folds, each not more than 5 mm in maximum length.
Grade B: One or more mucosal breaks more than 5 mm in maximum length, but not continuous between the tops of two mucosal folds.
Grade C: Mucosal breaks that are continuous between the tops of tow or more mucosal folds, but which involve less that 75% of the esophageal circumference.
Grade D: Mucosal breaks which involve at least 75% of the esophageal circumference.
The presence or absence of strictures, ulcers, and/or Barrett’s esophagus much be noted separately, e.g., “Grade B with stricture”.

Criteria used in Hatlebakk, 1993:

Grade 1: red streaks or spots along the ridge of the folds in the distal esophagus, covered or not by fibrinous Exudate
Grade 2: Broader lesions, each involving the entire width of a fold or coalescing into fields or erythema, covered or not with fibrinous exudates
Grade 3: Stricture or endoscopically visible ulcer in distal esophagus.
Grade 1: red streaks or spots along the ridge of the folds in the distal esophagus, covered or not by fibrinous Exudate
Grade 2: Broader lesions, each involving the entire width of a fold or coalescing into fields or erythema, covered or not with fibrinous exudates
Grade 3: Stricture or endoscopically visible ulcer in distal esophagus.

Criteria used in Castell, 1996, Howden, 2002, Richter 2001b:

Grade 0: normal-appearing mucosa
Grade 1: mucosal edema, hyperemia, and/or friability
Grade 2: one or more erosions/ulcerations involving <10% of the distal 5 cm of the esophagus
Grade 3: erosions/ulcerations involving 10–50% of the distal 5 cm of the esophagus or an ulcer 3–5 mm in diameter. In cases of Barrett’s esophagus, the area 5 cm proximal to the squamocolumnar junction was evaluated
Grade 4: multiple erosions involving >50% of the distal 5 cm of the esophagus or a single ulcer > 5mm in diameter.

GOLD COPD STAGING:

Stage I	Mild COPD	FEV1/FVC<0.70	FEV1≥ 80% normal
Stage II	Moderate COPD	FEV1/FVC<0.70	FEV1 50-79% normal
Stage III	Severe COPD	FEV1/FVC<0.70	FEV1 30-49% normal
Stage IV	Very Severe COPD	FEV1/FVC<0.70	FEV1 <30% normal, or <50% normal with chronic respiratory failure present*

* Usually, this means requiring long-term oxygen therapy