Clinical scores in guillian Barre syndrome
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"Guillain-Barre syndrome"[MeSH Terms] AND clinical score
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Hughes disability scale GBS scoring clinical scores Guillain-Barre syndrome EGOS mEGOS EGRIS
I now have comprehensive data on all the major GBS clinical scores. Let me compile the full answer.
Clinical Scores in Guillain-Barré Syndrome (GBS)
Several validated scoring systems are used in GBS for disability grading, outcome prediction, and respiratory failure risk assessment.
1. GBS Disability Scale (Hughes Scale)
The most widely used tool in GBS, originally described by Hughes et al. (1978) and adapted by van Koningsveld et al. (2007). It grades functional status on a 0-6 scale:
| Score | Description |
|---|---|
| 0 | Healthy state |
| 1 | Minor symptoms; capable of running |
| 2 | Able to walk ≥10 m without assistance, but unable to run |
| 3 | Able to walk 10 m across an open space with help |
| 4 | Bedridden or chairbound |
| 5 | Requiring assisted ventilation for at least part of the day |
| 6 | Dead |
This scale is used at admission, nadir, and discharge. It also feeds into the EGOS prognostic model. In clinical trials, improvement of ≥1 grade is the standard endpoint (e.g., the van Koningsveld EGOS paper used it as the primary outcome measure).
2. Erasmus GBS Outcome Score (EGOS)
A validated prognostic tool applied at 14 days of admission to predict inability to walk independently at 6 months. Uses three parameters:
- Age at onset (≤40 vs. >40 years)
- Preceding diarrheal illness (Campylobacter jejuni infection, within 4 weeks)
- GBS Disability Score at the time of assessment
Higher EGOS scores correlate with greater risk of being unable to ambulate at 6 months.
3. Modified Erasmus GBS Outcome Score (mEGOS)
Applied earlier - at day 7 of admission - to allow earlier prognostication. Key difference from EGOS: replaces the GBS Disability Score with the MRC sum score (Medical Research Council muscle strength score), making it usable before the nadir is clearly established. Parameters:
- Age at first symptom onset
- Preceding diarrheal illness (yes/no)
- MRC sum score at day 7
The mEGOS calculator (Medscape) predicts the probability of being unable to walk independently during the first 6 months. It was developed and validated in a Dutch GBS cohort and subsequently validated in a Japanese cohort.
- Rosen's Emergency Medicine notes: "There is no score to predict outcomes from the ED" - both EGOS and mEGOS are inpatient tools. - Rosen's Emergency Medicine, p. 1519
4. Erasmus GBS Respiratory Insufficiency Score (EGRIS)
A Dutch-derived score predicting respiratory failure within the first 7 days of hospitalization. Based on three factors:
| Measure | Categories | Score |
|---|---|---|
| Days between onset of weakness and hospitalization | >7 days | 0 |
| 4-7 days | 1 | |
| ≤3 days | 2 | |
| Facial and/or bulbar weakness at hospitalization | Absent | 0 |
| Present | 1 | |
| MRC sum score at hospitalization | 60 | 0 |
| 51-60 | 1 | |
| 41-50 | 2 | |
| ≤40 | 3 |
Total score range: 0-7
| EGRIS Score | Risk of Respiratory Failure in 1st Week |
|---|---|
| 0-2 | Low risk (~1%) |
| 3-4 | Intermediate risk (~12-24%) |
| 5-7 | High risk (~65-75%) → admit to ICU |
Patients with EGRIS 5-7 should be admitted to the ICU for close observation and timely intubation. - Fishman's Pulmonary Diseases, p. 1506; Miller's Anesthesia, p. 12035
5. Criteria for Intubation and Mechanical Ventilation (The "20-15-12 Rule")
Alongside EGRIS, these bedside thresholds guide ventilatory management:
Major criteria (1 sufficient to intubate):
- Hypercarbia (PaCO₂ ≥48 mmHg)
- Hypoxemia (PaO₂ ≤56 mmHg)
- Vital capacity (VC) <15 cc/kg
Minor criteria (2 required):
- Ineffective cough
- Impaired swallowing
- Atelectasis
Additional clinical thresholds from Miller's Anesthesia:
- FVC <20 mL/kg = indication for close observation
- FVC <15 mL/kg = probable intubation
- MIP (maximal inspiratory pressure) < -30 cmH₂O = imminent failure
Hypercarbia is a late sign - average PaCO₂ at intubation is only 43 mmHg when FVC is <12 cc/kg. Do not wait for it. - Fishman's Pulmonary Diseases, p. 1506
6. MRC Sum Score (Bedside Muscle Strength)
Not a GBS-specific score, but central to EGRIS and mEGOS. Tests 6 muscle groups bilaterally (shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, ankle dorsiflexion), each scored 0-5. Maximum = 60 (normal).
- MRC sum score ≤40 carries the highest weight in EGRIS (score 3/3 for that parameter).
- Peripheral muscle strength does not reliably predict respiratory muscle weakness, as the distribution of weakness between respiratory and non-respiratory muscles is not uniform in GBS. - Fishman's Pulmonary Diseases, p. 1506
Quick Reference Summary
| Score | Timing | Purpose |
|---|---|---|
| Hughes Disability Scale | Admission, nadir, discharge | Functional grading (0-6) |
| EGOS | Day 14 of admission | Predicts inability to walk at 6 months |
| mEGOS | Day 7 of admission | Earlier functional prognosis using MRC |
| EGRIS | Admission (first 7 days) | Predicts respiratory failure risk |
| MRC Sum Score | Any time | Muscle strength; input to EGRIS/mEGOS |
| 20-15-12 Rule | ICU monitoring | Thresholds for intubation decision |
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