Table 1.

Grading system to guide evaluation of Neurovascular, Gastrointestinal and cutaneous systems.⁶

Symptom	1st Degree	2nd Degree	3rd Degree	4th Degree
Neurovascular system
Nausea	Mild	Moderate	Severe	Extremely severe
Vomiting	1/day, occasional	2–5/day, intermittent	6–10/day, persistent	More than 10/day, refractory
Anorexia	Able to eat	Decreased intake	Intake minimal	Require parenteral nutrition
Fatigue	Nil	Work impaired	Needs assistance for ADLs	Nil ADLsa
Fever	Less than 38 °C	38–40 °C	More than 40 °C and less than 24 h	More than 40 °C and more than 24 h
Headache	Mild	Moderate	Intense	Extremely severe
Hypotension	HR more than 100/BP more than 100/170 mm Hg	BP less than100/70 mm Hg	BP less than 90/60 mm Hg and transient	BP less than 80/? Mm Hg and persistent
Neurological deficits	Difficult to detect	Detected easily	Neurological impairment prominent	Life threatening deficit
Cognitive deficits	Mild loss	Moderate loss	Severe impairment	Impairment complete
Gastrointestinal system
Diarrhea
Frequency	2–3 stools/day	4–6 stools/day	7–9 stools/day	More than 10 stools/day
Consistency	Bulky	Loose	Persistent	Watery
Bleeding	Occult	Intermittent	Loose	Persistent with large amount
Abdominal pain	Mild	Moderate	Intense	Severe
Cutaneous system
Erythema	Mild and transient	Moderate, less than 10% of BSAb	Marked; 10–40% of BSAb	Severe; more than 40% of BSAb
Sensation/itching	Pruritus	Slight with intermittent pain	Moderate with continuous pain	Severe with continuous pain
Swelling/edema	Present but asymptomatic	Symptomatic	Mild dysfunction	Total dysfunction
Blistering	Rare	Rare	Bullae with sterile fluid	Bullae with hemorrhage
Desquamation	Absent	Dry and patchy	Moist patchy	Moist and confluent
Ulcer/necrosis	Epidermal are only	Dermal	Subcutaneous	Muscle or/and bone involvement
Hair loss	Thinning	Visible and patchy	Complete but reversible	Complete but irreversible
Onycholysis	Nil	Mild	Mild	Complete

Note: Adapted from: Fliedner T.M., Friesecke I., Beyrer K., British Institute of Radiology, editors. Medical management of radiation accident—manual on the Acute Radiation Syndrome (METREPOL European Commission concerted action) British Institute of Radiology; Oxford: 2001. p. 1–66; compendium p. C1–C21. Table no. Nil, Neurovascular system; p C3; Table No. Nil, Haematopoietic system; P C4; Table No. Nil, Cutaneous System; p C4; Gastrointestinal system; p C5.

^aADLs: activities of daily living.

^bBSA: body surface area.