Clinical Criteria

Select All That Apply

Grade 1: Asymptomatic or mild symptoms; intervention not indicated
Grade 2: Moderate pain; not interfering with oral intake; modified diet indicated
Grade 3: Severe pain; interfering with oral intake
Grade 4: Life-threatening consequences; urgent intervention indicated
Grade 5: Death

Grade 1: 1-2 episodes (separated by 5 minutes) in 24 hrs
Grade 2: 3-5 episodes (separated by 5 minutes) in 24 hrs
Grade 3: ≥ 6 episodes (separated by 5 minutes) in 24 hrs; tube feeding, TPN or hospitalization indicated
Grade 4 - Life threatening consequences; urgent intervention indicated
Grade 5 - Death

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADL
Grade 3: Severe pain; limiting self care ADL
Grade 4: NA
Grade 5: NA