common scales for assessment of patients and treatment of patients. Most important scoring systems that are used in healthcare facilities.

2. Glasgow Coma Scale (GCS) :
It is the most common scoring system used to
describe the level of consciousness in a person
following a traumatic brain injury.
Score ranges from 3 to 15.

3. Asia impairment Scale :
The American Spinal Injury Association (ASIA)
developed a universal classification tool for Spinal
Cord Injury based on a standardized sensory and
motor assessment.

4. Behavioural pain scale :
BPS can be used to assess pain in
the adults, including those in the
ICU. It can be used for intubated
patients and non-intubated
patients.

5. CPOT : (Critical Care Pain Observation Tool)
•The pain assessment tool, CPOT is based on 4
domains :
The patient’s facial expression, body movements,
compliance with ventilator (or voice use for non-
intubated patients), and muscle tension.
•The total score can vary between 0 and 8, where
0 indicates no pain behaviour and 8 indicates clear
signs of pain behaviour.

7. Braden Scale :
The braden scale for predicting pressure ulcer risk.

9. Norton Scale :
This scale is also used to assess
the risk for pressure ulcer in
adult patients.

10. Waterlow Scale :
This scale gives an
estimated risk for the
development of a pressure
sore in a given patient.

11. VIP Scale :
The Visual Infusion
Phlebitis (VIP) score tool
for assessment of the
early signs of phlebitis,
along with prompt
removal of peripheral
intravenous cannulas.

12. CPIS :
Clinical Pulmonary
Infection Score (CPIS) is
a screening tool for
Ventilatory Associated
Pneumonia (VAP).

13. BOAS Scale :
The Beck Oral Assessment Scale is used to assess the oral
cavity of the person.

14. NIHSS :
The National Institutes of
Health Stroke Scale, or NIH
Stroke Scale (NIHSS) is a tool
used by health care providers
to objectively quantify the
impairment caused by a stroke.

15. FLACC Scale :
The Face, Legs, Activity, Cry,
Consolability Scale is a
measurement use to assess pain
for children between age of 2
months and 7 years or
individuals that are unable to
communicate their pain.

16. CRIES Scale :
A neonatal postoperative pain measurement score.
C- Crying
R- Requires increased oxygen administration
I- Increased Vital Signs
E- Expression
S- Sleeplessness

17. FOUR Score :
F – Full ; O – Outline of ; U – Un-
Responsiveness.
The FOUR Score is a clinical grading scale
designed for use by medical
professionals in the assessment of
patients with impaired level of
consciousness.

18. GCS – Pupil Score :
GCS informs about patient’s responsiveness as reflected in the GCS
Score and Pupil reaction
The GCS-P is calculated by subtracting the Pupil Reactivity Score (PRS)
from the Glasgow Coma Scale total score :
GCS –(P) = GCS - PRS

19. CDR Scale :
The Clinical Dementia Rating or CDR is a numeric
scale that is used to quantify the severity of
symptoms of Dementia.

20. RASS :
The Richmond Agitation and Sedation Scale is a method to assess patient’s
level of sedation in ICU (Intensive Care Unit).

21. ABBEY pain scale :
The ABBEY pain scale is a pain assessment tool developed for use in demented non verbal
patients.

22. MMSE (Folstein test) :
The Mini Mental State
Exam is a 30 point
questionnaire, widely used
test of cognitive function.
Any score of 24 or more
(out of 30) indicates a
normal cognition.

23. PANAS :
Positive And Negative
Affect Schedule is a
self-report
questionnaire that
consists of 2-10 items
scale to measure both
positive and negative
affect.

24. SOFA Score :
Sequential Organ Failure
Assessment Score, previously
known as the Sepsis-related organ
failure assessment score is used to
track person’s status during the
stay in an ICU to determine the
extent of person’s organ functions
on rate of failure.

25. APACHE II Score :
Acute Physiology, Age, Chronic Health Evaluation.
The APACHE II Scoring system is designed to measure
the severity of disease in patients admitted to the ICU.