Grading system for response of neurovascular, gastrointestinal and cutaneous systems.
| Symptom . | Degree 1 . | Degree 2 . | Degree 3 . | Degree 4 . |
|---|---|---|---|---|
| † Fatigue: self-recognized state of overwhelming, sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest. | ||||
| ‡ Neurological deficits: reflex status (including corneal reflexes), papilledema, ataxia and other motor signs/sensory signs. | ||||
| § Cognitive deficits: memory, reasoning and/or judgment. | ||||
| * Cutaneous system: the extent of the skin area affected is decisive and should be documented for all skin changes. ADLs: activities of daily living; LOC: loss of consciousness; BSA: body surface area. | ||||
| Modified from TM Fliedner, I Friesecke and K Beyrer.13 | ||||
| Neurovascular System | ||||
| Nausea | mild | moderate | intense | excruciating |
| Vomiting | occasional, 1/day | intermittent, 2–5/day | persistent, 6–10/day | refractory >10/day |
| Anorexia | able to eat | intake decreased | minimal intake | parenteral nutrition |
| Fatigue syndrome† | able to work | impaired work | assistance for ADLs | no ADLs |
| Fever | < 38°C | 38–40°C | > 40°C < 24 h | > 40°C > 24 h |
| Headache | minimal | moderate | intense | excruciating |
| Hypotension | HR > 100 / BP > 100/170 | BP < 100/70 | BP < 90/60; transient | BP < 80/?; persistent |
| Neurological deficits‡ | barely detectable | easily detectable | prominent neurological | life threatening, LOC |
| Cognitive deficits§ | minor loss | moderate loss | major impairment | complete impairment |
| Gastrointestinal System | ||||
| Diarrhea | ||||
| Frequency | 2–3 stools/d | 4–6 stools/d | 7–9 stools/d | ≥ 10 stools/day |
| Consistency | bulky | loose | loose | watery |
| Bleeding | occult | intermittent | persistent | persistent with large amount |
| Abdominal Cramps/Pain | minimal | moderate | intense | excruciating |
| Cutaneous System | ||||
| Erythema* | minimal and transient | moderate, < 10% BSA | marked; 10–40% BSA | severe; > 40% BSA |
| Sensation/Itching | pruritus | slight & intermittent pain | moderate & persistent pain | severe & persistent pain |
| Swelling/Edema | present; asymptomatic | symptomatic; tension | secondary dysfunction | total dysfunction |
| Blistering | rare, sterile fluid | rare, hemorrhage | bullae, sterile fluid | bullae, hemorrhage |
| Desquamation | absent | patchy dry | patchy moist | confluent moist |
| Ulcer/Necrosis | epidermal only | dermal | subcutaneous | muscle/bone involvement |
| Hair loss | thinning, not striking | patchy, visible | complete and reversible | complete and irreversible |
| Onycholysis | absent | partial | partial | complete |
| Symptom . | Degree 1 . | Degree 2 . | Degree 3 . | Degree 4 . |
|---|---|---|---|---|
| † Fatigue: self-recognized state of overwhelming, sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest. | ||||
| ‡ Neurological deficits: reflex status (including corneal reflexes), papilledema, ataxia and other motor signs/sensory signs. | ||||
| § Cognitive deficits: memory, reasoning and/or judgment. | ||||
| * Cutaneous system: the extent of the skin area affected is decisive and should be documented for all skin changes. ADLs: activities of daily living; LOC: loss of consciousness; BSA: body surface area. | ||||
| Modified from TM Fliedner, I Friesecke and K Beyrer.13 | ||||
| Neurovascular System | ||||
| Nausea | mild | moderate | intense | excruciating |
| Vomiting | occasional, 1/day | intermittent, 2–5/day | persistent, 6–10/day | refractory >10/day |
| Anorexia | able to eat | intake decreased | minimal intake | parenteral nutrition |
| Fatigue syndrome† | able to work | impaired work | assistance for ADLs | no ADLs |
| Fever | < 38°C | 38–40°C | > 40°C < 24 h | > 40°C > 24 h |
| Headache | minimal | moderate | intense | excruciating |
| Hypotension | HR > 100 / BP > 100/170 | BP < 100/70 | BP < 90/60; transient | BP < 80/?; persistent |
| Neurological deficits‡ | barely detectable | easily detectable | prominent neurological | life threatening, LOC |
| Cognitive deficits§ | minor loss | moderate loss | major impairment | complete impairment |
| Gastrointestinal System | ||||
| Diarrhea | ||||
| Frequency | 2–3 stools/d | 4–6 stools/d | 7–9 stools/d | ≥ 10 stools/day |
| Consistency | bulky | loose | loose | watery |
| Bleeding | occult | intermittent | persistent | persistent with large amount |
| Abdominal Cramps/Pain | minimal | moderate | intense | excruciating |
| Cutaneous System | ||||
| Erythema* | minimal and transient | moderate, < 10% BSA | marked; 10–40% BSA | severe; > 40% BSA |
| Sensation/Itching | pruritus | slight & intermittent pain | moderate & persistent pain | severe & persistent pain |
| Swelling/Edema | present; asymptomatic | symptomatic; tension | secondary dysfunction | total dysfunction |
| Blistering | rare, sterile fluid | rare, hemorrhage | bullae, sterile fluid | bullae, hemorrhage |
| Desquamation | absent | patchy dry | patchy moist | confluent moist |
| Ulcer/Necrosis | epidermal only | dermal | subcutaneous | muscle/bone involvement |
| Hair loss | thinning, not striking | patchy, visible | complete and reversible | complete and irreversible |
| Onycholysis | absent | partial | partial | complete |