Cumulative Illness Rating Scale-Geriatric (CIRS-G)
Quantifies burden of disease in elderly patients (comorbidity scale).
When to Use
Why Use
No problem
0MI >5 years ago, occasional angina treated with meds as needed
+1CHF compensated with meds, daily antianginal meds, left ventricular hypertrophy, atrial fibrillation, bundle branch block, daily antiarrhythmic drugs
+2MI ≤5 years ago, abnormal stress test, or past PTCA or CABG
+3Marked activity restriction secondary to cardiac status (i.e., unstable angina or intractable CHF)
+4No problem
0Hypertension compensated with salt restriction and weight loss, cholesterol >200 mg/dL
+1Daily antihypertensive meds, one symptom of atherosclerotic disease (angina, claudication, bruit, amaurosis fugax, absent pedal pulses), aortic aneurysm <4 cm
+2≥2 symptoms of atherosclerosis
+3Previous vascular surgery, aortic aneurysm ≥4 cm
+4No problem
0Hemoglobin: females 10-12 g/dL, males 12-14 g/dL, anemia of chronic disease
+1Hemoglobin: females 8 to <10 g/dL, males 10 to <12 g/dL, anemia secondary to iron/vitamin B-12/folate deficiency or chronic renal failure, total WBC 2,000-4,000
+2Hemoglobin: females <8 g/dL, males <10 g/dL, total WBC <2,000
+3Any leukemia or lymphoma
+4No problem
0Recurrent episodes of acute bronchitis, current treated asthma with inhalers as needed, cigarette smoker 10-20 pack years
+1X-ray evidence of COPD, requires daily theophylline or inhalers, treated for pneumonia two or more times in the past 5 years, smoked 21-40 pack years
+2Limited ambulation secondary to limited respiratory capacity, requires oral steroids for lung disease, smoked >40 pack years
+3Requires supplemental oxygen, ≥1 episode of respiratory failure requiring assisted ventilation, any lung cancer
+4No problem
0Corrected vision 20/40, chronic sinusitis, mild hearing loss
+1Corrected vision 20/60 or reads newsprint with difficulty, requires hearing aid, chronic sinonasal complaints requiring medication, requires medication for vertigo
+2Partially blind (requires an escort to venture out), unable to read newsprint, conversational hearing still impaired with hearing aid
+3Functional blindness, functional deafness, laryngectomy, requires surgical intervention for vertigo
+4No problem
0Hiatal hernia, heartburn complaints treated with as-needed meds
+1Needs daily H₂ blocker or antacid, documented gastric or duodenal ulcer within 5 years
+2Active ulcer, guaiac positive stools, any swallowing disorder or dysphagia
+3Gastric cancer, history of perforated ulcer, melena or hematochezia from upper GI source
+4No problem
0Constipation managed with meds as needed, active hemorrhoids, status post hernia repair
+1Requires daily bulk laxatives or stool softeners, diverticulosis, untreated hernia
+2Bowel impaction in the past year, daily use of stimulant laxatives or enemas
+3Hematochezia from lower GI source, currently impacted, diverticulitis flare up, status post bowel obstruction, bowel carcinoma
+4No problem
0History of hepatitis >5 years ago, cholecystectomy
+1Mildly elevated LFTs (≤150% of normal), hepatitis within 5 years, cholelithiasis, daily or heavy alcohol use within 5 years
+2Elevated bilirubin (total >2 mg/dL), marked elevation of LFTs (>150% of normal), requires supplemental pancreatic enzymes for digestion
+3Clinical or lab evidence of biliary obstruction, any biliary tree carcinoma, cholecystitis, pancreatitis, active hepatitis
+4No problem
0Kidney stone passage within the past 10 years or asymptomatic kidney stone, pyelonephritis within 5 years
+1Serum creatinine 1.5-3.0 mg/dL without diuretic or antihypertensive medication
+2Serum creatinine >3.0 mg/dL OR serum creatinine >1.5 mg/dL on diuretic, antihypertensive, or bicarbonate therapy, current pyelonephritis
+3Requires dialysis, renal carcinoma
+4No problem
0Stress incontinence, hysterectomy, BPH without urinary symptoms
+1Abnormal pap smear, frequent UTIs (≥3 in past year), urinary incontinence (non-stress) in females, BPH with hesitancy or frequency, current UTI, any urinary diversion procedure, status post TURP
+2Prostate cancer in situ (i.e., found incidentally during TURP), vaginal bleeding, cervical carcinoma in situ, hematuria, status post urosepsis in past year
+3Acute urinary retention, any GU carcinoma except as above
+4No problem
0Uses meds as needed for arthritis or has mildly limited activities of daily living (ADLs) from joint pathology, excised non-melanoma skin cancers, skin infections requiring antibiotics within a year
+1Daily antiarthritic meds or use of assistive devices or moderate limitation in ADLs, daily meds for chronic skin conditions, melanoma without metastasis
+2Severely impaired ADLs secondary to arthritis, requires steroids for arthritic condition, vertebral compression fractures from osteoporosis
+3Wheelchair bound, severe joint deformity or severely impaired usage, osteomyelitis, any bone or muscle carcinoma, metastatic melanoma
+4No problem
0Frequent headaches requiring meds as needed without interference with daily activities, history of TIA phenomena (at least one)
+1Requires daily meds for chronic headaches or headaches that regularly interfere with daily activities, status post CVA without significant residual, mild neurodegenerative disease (Parkinson's, MS, ALS, etc)
+2Status post CVA with mild residual dysfunction, any CNS neurosurgical procedure, moderate neurodegenerative disease
+3Status post CVA with residual functional hemiparesis or aphasia, severe neurodegenerative disease
+4No problem
0Diabetes mellitus compensated with diet, obesity (BMI >30), requires thyroid hormone replacement
+1Diabetes mellitus requiring insulin or oral agents, fibrocystic breast disease
+2Any electrolyte disturbance requiring hospital treatment, morbid obesity (BMI >45)
+3Brittle or poorly controlled diabetes mellitus or diabetic coma in the past year, requires adrenal hormone replacement, adrenal, thyroid, or breast carcinoma
+4No problem
0Minor psychiatric condition or history thereof: specifically, previous outpatient mental health treatment during a crisis, outpatient treatment for depression >10 years ago, current use of minor tranquilizers for episodic anxiety (occasional usage), mild early dementia
+1A history of major depression (by DSM) within the past 10 years (treated or untreated), mild dementia, any previous psychiatric hospitalization, any psychotic episode substance abuse history >10 years ago
+2Currently meets DSM criteria for major depression or two or more episodes of major depression in the past 10 years, moderate dementia, current usage of daily anti-anxiety medication, currently meets DSM criteria for substance abuse or dependency, requires daily antipsychotic medication
+3Current mental illness requiring psychiatric hospitalization, institutionalization, or intensive outpatient management (e.g. patients with severe or suicidal depression, acute psychosis or psychotic decompensation, severe agitation from dementia, severe substance abuse, etc), severe dementia
+4Result:
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