Kuniak et al reported the Radiation Injury Severity Classification (RISC) system to describe the severity of an acute radiation exposure. The authors are from the University of Pittsburgh, Southern Urals Biophysics Institute, MAYAK Production Association and the University of Utah.
Parameters:
(1) gastrointestinal symptoms
(2) neurovascular symptoms
(3) hematological findings
|
Parameter |
Finding |
Points |
|---|---|---|
|
gastrointestinal symptoms |
none |
0 |
|
|
anorexia or nausea within 6 hours but without vomiting |
1 |
|
|
vomiting starting within 6 hours |
2 |
|
|
vomiting starting within 2 hours |
3 |
|
|
vomiting within 60 minutes AND (diarrhea or abdominal pain within 48 hours) |
4 |
|
|
vomiting within 30 minutes AND (recurrent diarrhea within 48 hours OR acute abdomen) |
5 |
|
neurovascular symptoms |
none |
0 |
|
|
single symptom (anxiety, fatigue, weakness, headache) |
1 |
|
|
multiple symptoms AND normotensive AND oriented |
2 |
|
|
mild confusion OR asymptomatic drop in blood pressure OR fever |
3 |
|
|
symptomatic hypotension with or without fever, confusion, severe subjective symptoms |
4 |
|
|
reversible severe hypotension, disorientation, ataxia |
5 |
|
|
shock or coma |
6 |
|
hematological findings |
lymphocyte count > 1250 per µL at 72 hours AND neutrophil count < 10,000 per µL at 72 hours |
0 |
|
|
lymphocyte count 1000 to 1250 per µL at 72 hours AND neutrophil count < 10,000 per µL at 72 hours |
1 |
|
|
lymphocyte count > 1250 per µL at 72 hours AND neutrophil count > 10,000 per µL at 72 hours |
1 |
|
|
lymphocyte count 500-999 per µL at 72 hours AND neutrophil count < 10,000 per µL at 72 hours |
2 |
|
|
lymphocyte count 1000-1250 per µL at 72 hours AND neutrophil count > 10,000 per µL at 72 hours |
2 |
|
|
lymphocyte count 100-499 per µL at 72 hours AND neutrophil count < 10,000 per µL at 72 hours |
3 |
|
|
lymphocyte count 500-999 per µL at 72 hours AND neutrophil count > 10,000 per µL at 72 hours |
3 |
|
|
lymphocyte count < 100 per µL at 72 hours AND neutrophil count < 10,000 per µL at 72 hours |
4 |
|
|
lymphocyte count 100-499 per µL at 72 hours AND neutrophil count > 10,000 per µL at 72 hours |
4 |
|
|
lymphocyte count < 100 per µL at 48 hours but >= 250 per µL at 24 hours |
5 |
|
|
lymphocyte count < 250 per µL within 12 hours |
6 |
where:
• Symptomatic hypotension involves pallor, tachycardia and/or orthostatic hypotension. A transient vasovagal reaction does not qualify.
• The hematological data in the table as printed in the paper does not make sense. The data above is an attempt to make sense of it.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• The higher the total score the more severe the exposure.
|
Mass Event |
Other |
Management |
|
0 to 6 |
0 to 5 |
outpatient followup |
|
7 to 13 |
6 to 15 |
inpatient care |
|
14 to 17 |
16 or 17 |
palliative care |
where:
• The assumption is that all 3 parameters move in tandem (a high score in 1 parameter is associated with high scores in the other 2).
Specialty: Hematology Oncology
