Revised Rickets Severity Score

Thacher et al reported the Rickets Severity Score for patients with nutritional rickets. It can be used for other forms of rickets

Parameters:

(1) grade for radius

(2) grade for ulna

Imaging Studies	Grade
normal growth plate with no changes of rickets	0
lucency of metaphyseal margin without fraying or irregularity	0.5
widened growth plate; irregularity of metaphyseal margin; without concave cupping	1
partial metaphyseal concavity or incomplete fraying of metaphyseal margin	1.5
metaphyseal concavity with fraying of margins	2

(3) grade for femur

(4) grade for tibia

Imaging Studies	Grade
normal growth plate with no changes of rickets	0
partial lucency; smooth margin of metaphysis visible	1
partial lucency; smooth margin of metaphysis not visible	2
complete lucency; epiphysis appears widely separated from distal metaphysis	3

Imaging Studies	Multiplier
up to 1 condyle (femur) or plateau (tibia) affected	0.5
both condyles (femur) or plateau (tibia) affected	1

wrist subscore =

= (grade for radius) + (grade for ulna)

knee subscore =

= ((multiplier for femur) * (grade for femur)) + ((multiplier for tibia) *(grade for tibia))

Interpretation:

• minimum wrist subscore: 0

• maximum wrist subscore: 4

• minimum knee subscore: 0

• maximum knee subscore: 6

• minimum total score: 0

• maximum total score: 10

• The higher the total score the greater the disease activity, deformity and impairment shown by the patient.

• A score < 1.5 is associated with low severity.

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