Development and Evaluation of a Summative Clinical Grading Tool

1986 ◽  
Vol 25 (5) ◽  
pp. 218-220
Author(s):  
Kathleen B Hillegas ◽  
Susan Valentine
Keyword(s):  
Clinical Grading

A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

2020 ◽  
Vol 133 (3) ◽  
pp. 800-807 ◽  
Author(s):  
Andreas Fahlström ◽  
Henrietta Nittby Redebrandt ◽  
Hugo Zeberg ◽  
Jiri Bartek ◽  
Andreas Bartley ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Intracerebral Hemorrhage ◽  
External Validation ◽  
Grading Scale ◽  
Ich Score ◽  
Gcs Score ◽  
Strength Of Association ◽  
Point Type ◽  
Clinical Grading

OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.RESULTSFactors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.CONCLUSIONSThe Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

Non-mydriatic ultrawide field scanning laser ophthalmoscopy compared with dilated fundal examination for assessment of diabetic retinopathy and diabetic macular oedema in Chinese individuals with diabetes mellitus

2018 ◽  
Vol 103 (9) ◽  
pp. 1327-1331 ◽  
Author(s):  
Simon K H Szeto ◽  
Raymond Wong ◽  
Jerry Lok ◽  
Fangyao Tang ◽  
Zihan Sun ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Clinical Examination ◽  
Macular Oedema ◽  
Chinese Population ◽  
Retrospective Cohort ◽  
Diabetic Macular Oedema ◽  
Scanning Laser ◽  
Scanning Laser Ophthalmoscopy ◽  
Chinese Cohort ◽  
Clinical Grading

AimsTo evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination.MethodsThis is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study.Results23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images.ConclusionThe performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined.

Significant Improvement of Survival by Intrasplenic Hepatocyte Transplantation in Totally Hepatectomized Rats

1996 ◽  
Vol 5 (3) ◽  
pp. 369-378 ◽  
Author(s):  
Birgit A.P.M. Vogels ◽  
Martinus A.W. Maas ◽  
Anne Bosma ◽  
Robert A.F.M. Chamuleau
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Survival Time ◽  
Histological Examination ◽  
Hepatocyte Transplantation ◽  
Shunt Operation ◽  
Blood Ammonia ◽  
Liver Atrophy ◽  
Arterial Blood ◽  
Clinical Grading

The effect of intrasplenic hepatocyte transplantation (HTX) was studied in an experimental model of acute liver failure in rats with chronic liver atrophy. Rats underwent a portacaval shunt operation on Day -14 to induce liver atrophy, and underwent total hepatectomy on Day 0 as a start of acute liver failure. Intrasplenic hepatocyte or sham transplantation was performed on Day -7, -3, or -1 (n = 4 to 6 per group). During the period following hepatectomy, mean arterial blood pressure was maintained above 80 mm Hg and hypoglycaemia was prevented. Severity of hepatic encephalopathy was assessed by clinical grading and EEG spectral analysis, together with determination of blood ammonia and plasma amino acid concentrations, and “survival” time. Histological examination of the spleen and lungs was performed after sacrifice. Intrasplenic hepatocyte transplantation resulted in a significant improvement in clinical grading in all transplanted groups (p < 0.05), whereas a significant improvement in EEG left index was seen only in the group with transplantation on Day -1 (p < 0.05). In contrast to hepatocyte transplantation 1 day before total hepatectomy, rats with hepatocyte transplantation 3 and 7 days before total hepatectomy showed a significant 3- and 2-fold increase in “survival” time compared to sham transplanted controls: HTX at Day -1: 7.5 ± 0.3 h vs. 5.9 ± 0.6 h (p > 0.05), HTX at Day -3:19.7 ± 3.7 h vs. 6.5 ± 0.3 h (p < 0.05), and HTX at Day -7: 13.8 ± 3.2 h vs. 6.3 ± 0.3 h (p < 0.05). Furthermore, rats with hepatocyte transplantation on Day -3 and -7 showed significantly lower blood ammonia concentrations after total hepatectomy (p < 0.0001). Histological examination of the spleens after sacrifice showed clusters of hepatocytes in the red pulp. Hepatocytes present in the spleen for 3 and 7 days showed bile accumulation and spots of beginning necrosis. The present data show that in a hard model of complete liver failure in portacaval shunted rats, intrasplenic hepatocyte transplantation is able to prolong “survival” time significantly 2- to 3-fold. The relevance of this observation for human application is discussed.

scholarly journals Oral submucous fibrosis: Correlation of clinical grading to various habit factors

2019 ◽  
Vol 9 (4) ◽  
pp. 363
Author(s):  
AtulA Bajoria ◽  
VikashK Jha ◽  
Srinivas Kandula ◽  
Sangamesh Ningappa Chinnannavar ◽  
Purnendu Rout ◽  
...  
Keyword(s):  
Oral Submucous Fibrosis ◽  
Submucous Fibrosis ◽  
Clinical Grading

scholarly journals Simple, Reproducible, and Efficient Clinical Grading System for Murine Models of Acute Graft-versus-Host Disease

2018 ◽  
Vol 9 ◽  
Author(s):  
Sina Naserian ◽  
Mathieu Leclerc ◽  
Allan Thiolat ◽  
Caroline Pilon ◽  
Cindy Le Bret ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Grading System ◽  
Murine Models ◽  
Host Disease ◽  
Graft Versus Host ◽  
Clinical Grading ◽  
Acute Graft

A clinicopathologic correlation of the idiopathic hypereosinophilic syndrome. II. Clinical manifestations

Blood ◽  
1981 ◽  
Vol 58 (5) ◽  
pp. 1021-1026 ◽  
Author(s):  
RT Schooley ◽  
MA Flaum ◽  
HR Gralnick ◽  
AS Fauci
Keyword(s):  
Hypereosinophilic Syndrome ◽  
Clinical Manifestations ◽  
Initial Therapy ◽  
Multiple Organ ◽  
Cytotoxic Agents ◽  
Grading System ◽  
Idiopathic Hypereosinophilic Syndrome ◽  
Splenic Enlargement ◽  
Organ Systems ◽  
Clinical Grading

Abstract The idiopathic hypereosinophilic syndrome, a disorder characterized by peripheral blood and bone marrow eosinophilia associated with single or multiple organ system dysfunction attributable to tissue invasion by eosinophils has, in the past, been associated with an extremely poor prognosis. Recently, we reported the favorable impact of a therapeutic protocol consisting of prednisone and/or hydroxyurea on the morbidity and mortality of this syndrome. We have reviewed the clinical and hematologic features upon admission and the subsequent clinical courses of 32 patients with this disease referred to the NIH between 1965 and 1979 in an effort to determine which features suggest a more rapidly progressive course. A grading system based on 22 clinical features involving the 8 organ systems commonly affected by the illness was devised. The disease followed a more aggressive course in patients with evidence of cardiac or neurologic dysfunction at the time of initial NIH evaluation. Although splenomegaly, in and of itself, caused little morbidity, splenic enlargement at presentation appeared to be a predictor of a more aggressive course. The clinical grading system accurately predicted which patients would require no specific antihypereosinophilic therapy, which patients would respond adequately to corticosteroids, and which patients would require therapy with cytotoxic agents. It is proposed that this clinical grading system, and the hematologic grading system outlined in the accompanying report be used as aids in the selection of initial therapy in this group of patients.

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