Cystic Fibrosis Scoring System - Medical Algorithm

Description

Shwachman and Kulczycki developed a clinical scoring system for pediatric patients with cystic fibrosis. This can be used to monitor the affected child over time. The authors are from Harvard Medical School.

Components (each worth 25 points):

(1) general activity

(2) physical examination

(3) nutrition

(4) chest X-ray findings

General Activity

Activity	School	Points
full and normal	regular attendance	25
lacks endurance and tires by end of day	good attendance	20
rests voluntarily during day and tires easily after exertion	fair attendance	15
dyspneic after short walk and rests a great deal	home teacher	10
orthopnea; chair or bed bound	minimal learning	5

Physical Examination

Cardiac	Respirations	Lung Auscultation	Emphysema	Points
normal pulse	no cough, normal respirations	clear	none	25
normal pulse at rest	normal respirations at rest, rare coughing	clear	none	20
	occasional cough, slight increase respiratory rate	coarse breath sounds, rarely localized rales	mild, early clubbing	15
	cough frequent and productive, chest retraction	rales usually present	moderate, with clubbing mild to moderate	10
right sided heart failure	severe coughing spells, tachypnea	extensive changes	extensive with moderate to severe clubbing	5

Nutrition

Weight and Height	Stools	Muscle Mass and Tone	Abdominal Distention	Points
>= 25th percentile	well-formed	good	none	25
15-20th percentile	slightly abnormal	fair	none	20
>= 3rd percentile	abnormal; large and poorly formed	poor tone with reduced mass	none or little	15
< 3rd percentile	poorly formed, fatty, bulky, offensive smell	flabby tone with reduced mass	mild to moderate	10
marked malnutrition	large, foul, frequent and fatty	very poor	protuberant, rectal prolapse	5

Chest X-ray Findings

Bronchovascular Markings	Emphysema	Signs of Infection	Points
none	none	none	25
minimal accentuation	early	none	20
increased	mild	variable	15
widespread atelectasis and minimal bronchiectasis	moderate	widespread areas (superimposed on atelectatic areas)	10
lobar atelectasis and bronchiectasis	extensive	extensive	5

total score =

= SUM(points for all 4 components)

Interpretation:

• minimum score: 20 (based on minimum score of 5 points for each component)

• maximum score: 100

• The higher the score the better the child's condition.

Total Score	Grade
86 - 100	excellent
71 - 85	good
56 - 70	mild
41 - 55	moderate
0 - 40	severe

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Description

Specialty

Objective

ICD-10

Cystic Fibrosis Scoring System of Shwachman and Kulczycki

Purpose: To evaluate a patient with cystic fibrosis using the scoring scheme of Shwachman and Kulczycki.

Description

Specialty

Objective

ICD-10