The clinical score of Lloyd-Still and Green can be used to evaluate children with either ulcerative colitis or Crohn's disease. It can be used to monitor disease activity over time and the effectiveness of therapy.
Parameters:
(1) general activity (maximum 10 points)
(2) physical examination (maximum 30 points)
(2a) abdomen
(2b) proctoscopy/perianal
(2c) arthritis
(2d) skin, stomatitis, eyes
(3) nutrition (maximum 20 points)
(3a) height
(3b) weight
(4) X-rays (maximum 15 points)
(5) laboratory (maximum 25 points)
(5a) hematocrit in percent
(5b) erythrocyte sedimentation rate (ESR)
(5c) white blood cell (WBC) count
(5d) serum albumin
|
Parameter |
Finding |
Points |
|---|---|---|
|
general activity |
normal school attendance; < 3 bowel movements per day |
10 |
|
|
lacks endurance; misses < 4 weeks per school year; 3-5 bowel movements per day |
5 |
|
|
severely restricted activity; fever; requires home tutor; > 5 bowel movements per day |
1 |
|
abdomen |
normal |
10 |
|
|
mass |
5 |
|
|
distention, tenderness |
1 |
|
proctoscopy and perianal examination |
normal, no fissure |
10 |
|
|
friability, 1 fissure |
5 |
|
|
ulcers, pseudopolyps, bleeding, multiple fissures, fistulas |
1 |
|
arthritis |
none |
10 |
|
|
1 joint involved, arthralgia |
5 |
|
|
multiple joints |
1 |
|
skin, stomatitis, eyes |
normal |
10 |
|
|
mild stomatitis |
5 |
|
|
erythema nodosum, pyoderma, severe stomatitis, uveitis |
1 |
|
height |
> 2 inches per year |
10 |
|
|
less than optimal percent |
5 |
|
|
no growth |
1 |
|
weight |
normal |
10 |
|
|
no gain |
5 |
|
|
weight loss |
1 |
|
X-rays |
normal |
15 |
|
|
ileitis, colitis to splenic flexure |
10 |
|
|
total colon or ileocolic involvement |
5 |
|
|
toxic megacolon, obstruction |
1 |
|
hematocrit |
> 40 percent (use > 35 in implementation) |
5 |
|
|
25 - 35 |
3 |
|
|
< 25 |
1 |
|
ESR |
normal (use < 20 in implementation) |
5 |
|
|
20 - 40 |
3 |
|
|
> 40 mm in first hour |
1 |
|
WBC count |
normal (use < 11,000 in implementation) |
5 |
|
|
<= 20,000 per µL (use 11,000 - 20,000 in implementation) |
3 |
|
|
> 20,000 per µL |
1 |
|
serum albumin |
normal (use >= 3.5 in implementation) |
10 |
|
|
3 g/dL (use 2.5-3.4 in implementation) |
5 |
|
|
< 2.5 g/dL |
1 |
from Table 1, page 621
where:
• For hematocrit, Table 1 has "> 40" and "25-35" with no coverage of 36-40.
• Erythrocyte sedimentation rate (ESR) is measured by the Westergren method and the normal was < 15 mm in the first hour.
• WBC count and albumin show age-dependent reference ranges, but for simplicity used single values.
clinical score =
= SUM(points for parameters)
Interpretation:
• minimum score: 12
• maximum score: 100
• The higher the score, the better the clinical condition of the patient.
|
Clinical Score |
Disease Activity |
|---|---|
|
>= 90 |
inactive |
|
80 - 89 |
minimal |
|
70 - 79 |
mild |
|
50 - 69 |
moderate |
|
30 - 49 |
severe |
|
< 30 |
very severe |
Limitations:
• A single score may not be adequate to cover both ulcerative colitis and Crohn's disease.
Specialty: Gastroenterology
ICD-10: ,
