Michelini et al reported the Lymphatic Clinical Severity Score (LCSS) for evaluation of a patient with peripheral lymphatic diseases. The authors are from Mhospital San Giovanni Battista, University of Rome and IRCCS Casa Ollievo della Sofferenza in Italy.
Patient selection: peripheral edema
Parameters:
(1) lymphatic edema
(2) increase in tissue consistency
(3) inflammation
(4) skin dystrophy
(5) recurrent dermato-lymphangio-adenitis
(6) pain
(7) lymph ulcerations
(8) articular involvement
(9) muscular hypotrophy
(10) compression therapy
|
Parameter |
Finding |
Points |
|
lymphatic edema |
none |
0 (none) |
|
|
occasional swelling; reversible |
1 (mild) |
|
|
permanent |
2 (moderate) |
|
|
elephantiasis |
3 (severe) |
|
tissue consistency |
none |
0 |
|
|
focal |
1 |
|
|
distal third of the limb |
2 |
|
|
proximal limb |
3 |
|
inflammation |
none |
0 |
|
|
limited, affects less than third of limb |
1 |
|
|
diffuse, affects less than a third of limb |
2 |
|
|
diffuse, affects more than a third of limb |
3 |
|
skin dystrophy |
none |
0 |
|
|
limited to the marginal area |
1 |
|
|
diffuse; affects less than a third of limb |
2 |
|
|
diffuse; affects more than a third of limb |
3 |
|
recurrent adenitis |
none |
0 |
|
|
history of 1 episode |
1 |
|
|
history of 2 episodes |
2 |
|
|
history of 3 or more episodes |
3 |
|
pain |
none |
0 |
|
|
occasional, no treatment needed |
1 |
|
|
occasional, analgesic needed; moderate restriction on daily activities |
2 |
|
|
frequent or constant; severe limits on activities of daily living |
3 |
|
lymph ulceration |
none |
0 |
|
|
1 |
1 |
|
|
2 |
2 |
|
|
>= 3 |
3 |
|
articular involvement |
none |
0 |
|
|
1 major joint |
1 |
|
|
2 major joints |
2 |
|
|
3 or more major joints |
3 |
|
muscular hypertrophy |
none |
0 |
|
|
limited to marginal area |
1 |
|
|
diffuse, affects less than a third of limb |
2 |
|
|
diffuse, affects more than a third of limb |
3 |
|
compression therapy |
none |
0 |
|
|
intermittent use of compression |
1 |
|
|
compression use during the day |
2 |
|
|
constant use |
3 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 30
• The higher the score the more severe the lymphedema.
|
Total Score |
Clinical Level |
Management |
|
<= 5 |
insignificant |
monitor |
|
6 to 15 |
mild |
outpatient |
|
16 to 22 |
moderate |
day hospital |
|
23 to 30 |
severe |
treat as inpatient |
