Patient selection: hepatic encephalopathy
Grade 4 items:
(1) no eyes opening
(2) no verbal or voice response
(3) no reaction to simple commands
Grade 3 items:
(1) somnolence
(2) confusion
(3) disoriented to place
(4) bizarre behavior, anger or rage
(5) clonus, rigidity, nystagmus and/or positive Babinski sign
(6) mental control = 0 (indication of confusion; a subtest of the Wechsler Memory Scale Revised)
Grade 2 items:
(1) lethargy
(2) loss of time
(3) slurred speech
(4) hyperactive reflexes
(5) inappropriate behavior
(6) slow responses (mental control score < 4)
(7) amnesia for recent events
(8) anxiety
(9) impaired simple computations
Grade 1 items:
(1) sleep disorder or impaired sleep pattern
(2) tremor
(3) impaired complex computations
(4) shortened attention span
(5) impaired construction ability
(6) euphoria or depression
If all 3 Grade 4 items are present, then Grade 4.
If >= 3 Grade 3 items are present, then Grade 3.
If >= 2 Grade 2 items (in range 1 to 5) AND if >= 3 items (in range 6 to 9) then Grade 2.
If >= 4 Grade 1 items then Grade 1.
Else Grade 0.
where:
• The presence of a higher grade item does not appear to carry over to a lower grade.
