So I can easily find references on how to grade murmurs, deep tendon reflexes, and muscle strength. However I cannot find a good source on how to grade pitting edema. A quick google search indicates that the grade (1+, 2+, etc) depends on the speed (in seconds) it takes for the indentation to go away. On the other hand one of my clinic preceptors told me that it is based on the distribution (such as 1+ if it only involves the ankles, 2+ if edema reaches the knee, etc). Anyone have definite answers? Thanks.
Pitting edema grading
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Trace edema means you can detect it, but it's hardly more than a light line from a sock. 1+ is mild, but you can definitely see a finger dent. 2+ is significant edema that leaves a divot from your finger, and 3+ means you can leave your entire hand impression on their calf/foot.
The scale doesn't indicate how high up the edema goes - you have to say 2+ edema extending to the knee.
The scale doesn't indicate how high up the edema goes - you have to say 2+ edema extending to the knee.
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This is basically what I've gotten from a few different attendings. If indeed there is an actual grading system with instructions on how to grade it, the fact is that so many people go based on their own subjective opinion that I think it's kind of useless beyond tr="I think I sorta maybe saw it for a second," 1+="a little," 2+= "a lot," and 3+="play doh."
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Honestly, I think strength is the only parameter that has a standardized grading scheme that's widely used.
The only other constant is that everyone you talk to will believe that theirs is the "right" way.
The only other constant is that everyone you talk to will believe that theirs is the "right" way.
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There is no standardized or accepted manner for grading edema.
I was taught "push in for 5 seconds, watch how long it take to pop back out, 15 is 1, 30 is 2, etc"
I've heard others use the "push in, meh 1, some but not all the finger 2, finger submersion 3"
I've seen people use it to refer to how HIGH UP the fluid goes, not even the extent of the edema in one place.
To reduce confusion, I often say "2+ edema at the ankles, 1+ at the knee, absent at the hip"
If you look in Bate's, there's no comment. If you look in Sapira, there is no comment. If you look in the JAMA book on clinical diagnosis, yep, no comment.
Here are two speculations as to why: (1) The degree of edema isn't diagnostically or prognostically significant, it's just impressive. (2) Every system accurately conveys "meh, whoa, and OH GOD!" really well, even if the exact manner of determining the number isn't consistent.
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I like to use the penny method:
Press down for a few seconds. Estimate how many pennies would fit in the divot:
1 penny= 1+
2 pennies= 2+
You get the idea.
I have seen people use 1+ to the shins, 2+ to knees, 3+ to the hips etc. I don't like it though because a hospitalized patient with some edema is almost always going to have some hip/sacral edema b/c of laying in a hospital bed.
I don't like the speed method either b/c if they have very taught pitting edema, it is going to go away quickly but they still have tons of edema.
In the end, it's not only subjective but doctor dependent. Pick a style and be consistent.
0 = none
1 = less than your average CHF pt in some overload
2 = your average chf pt in some overload
3 = more than your average chf in some overload
4 = weeping edema
most people just stick to 2+, trace, or none. weeping edema is pretty rare
1 = less than your average CHF pt in some overload
2 = your average chf pt in some overload
3 = more than your average chf in some overload
4 = weeping edema
most people just stick to 2+, trace, or none. weeping edema is pretty rare
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