The Cumulative Illness Rating Scale (CIRS) was developed by Linn et al as a brief, comprehensive and reliable measure of a patient's health impairment. The authors were associated with the Veterans Administration Hospitals in Miami and Washington, DC.



Indicate for each item the term that best describes the degree of impairment. For illnesses that cause impairment on more than one of the items, more than one item must be rated. When more than one illness occurs for a given item, it is the total impairment from these illnesses that is rated.


Cardiovascular-Respiratory System:

(1) cardiac (heart only)

(2) vascular (blood, blood vessels and cells, marrow, spleen, lymphatics)

(3) respiratory (lungs, bronchi, trachea below the larynx)

(4) EENT (eyes, ears, nose, throat, larynx)

Gastrointestinal System:

(5) upper GI (esophagus, stomach, duodenum, biliary and pancreatic trees)

(6) lower GI (intestines, hernias)

(7) hepatic (liver only)

Genitourinary System:

(8) renal (kidneys only)

(9) other GU (ureters, bladder, urethra, prostate, genitals)

Musculo-Skeletal-Integumentary System:

(10) MSI (muscle, bone, skin)

Neuropsychiatric System:

(11) neurologic (brain, spinal cord, nerves)

(12) psychiatric (mental)

General System:

(13) endocrine metabolic (includes diffuse infections, poisonings)

Degree of Severity










extremely severe (life threatening)



total pathology score =

= SUM(points for all 13 items)


illness severity composite (from Parmalee et al) =

= SUM(points for all items except psychiatric) / 12


comorbidity composite (from Parmalee et al) =

= number of items with rating of 3, 4, or 5, excluding psychiatric


Modified versions:

(1) Parmelee et al modified the CIRS with (a) the addition of a 14th item for hypertension, (b) addition of "behavioral" to psychiatric, and (c) scoring over the range of 1 to 5.

(2) CIRS(G) of Miller et al was designed for use in the geriatric population and is described below.



• It probably would function best in a relatively healthy population of people with only a few disorders.

• The groupings like "blood, blood vessels, blood cells, marrow, spleen, lymphatics" seem overly inclusive, while lumping infectious disease with endocrine-metabolic strikes me as odd. In addition, some conditions like severe immune disorders are not represented at all. These limitations could be handled by expanding the number of entries from 13 to something like 25.

• The illness severity composite could make a patient with a life-threatening condition seem less affected than a person with a few mild conditions.


To read more or access our algorithms and calculators, please log in or register.