Venous Clinical Severity Scoring

Courtesy of VeinSpec EMR

Patient Name:_______________________________________________________________________

Side:_______________________________________________________________________________




0 1 2 3
Pain NONE OCCASIONAL, NOT RESTRICTING ACTIVITY OR REQUIRING PAIN MEDICATION DAILY MODERATE ACTIVITY LIMITATION; OCCASIONAL PAIN MEDICATION DAILY, SEVERE LIMITING ACTIVITIES OR REQUIRING REGULAR USE OF PAIN MEDICATIONS
Varicose Veins NONE FEW SCATTERED MULTIPLE; GREAT SAPHENOUS VEINS, CONFINED TO CALF AND THIGH EXTENSIVE; THIGH AND CALF OR GREAT AND SMALL SAPHENOUS DISTRIBUTION
Venous Edema NONE EVENING ANKLE SWELLING ONLY AFTERNOON SWELLING, ABOVE ANKLE MORNING SWELLING ABOVE ANKLE AND REQUIRING ACTIVITY CHANGE, ELEVATION
Venous Pigmentation NONE DIFFUSE, BUT LIMITED IN AREA AND OLD (BROWN) DIFFUSE OVER MOST OF GAITER DISTRIBUTION (LOWER THIRD) OR RECENT PIGMENTATION (PURPLE) WIDER DISTRIBUTION (ABOVE LOWER THIRD) PLUS RECENT PIGMENTATION
Inflammation NONE MILD CELLULITIS, LIMITED TO MARGINAL AREA AROUND ULCER MODERATE CELLULITIS, INVOLVES MOST OF (LOWER THIRD) SEVERE CELLULITIS (LOWER THIRD AND ABOVE) OR SIGNIFICANT
Induration NONE FOCAL, CIRCUMMALLEOLAR MEDIAL OR LATERAL, LESS THAN LOWER THIRD OF LEG ENTIRE LOWER THIRD OF LEG OR MORE
# Active Ulcers 0 1 2 > 2
Active Ulcer Duration 0 < 3 MONTHS 3-12 MONTHS NOT HEALED > 12 months
Active Ulcer Diameter 0 < 2 2-6 > 6
Compression Therapy NOT USED OR PATIENT NOT COMPLIANT INTERMITTANT USE OF STOCKINGS WEARS ELASTIC STOCKING MOST DAYS FULL COMPLIANCE, STOCKINGS+ELEVATION
Total