ECOG Score for Bedridden Patient with Old CVA and GCS 15/15
A bedridden patient with a history of CVA but with a GCS score of 15/15 should be assigned an ECOG performance status of 4.
Understanding ECOG Performance Status
The Eastern Cooperative Oncology Group (ECOG) Performance Status is a scale used to assess a patient's functional status and ability to perform daily activities. The scale ranges from 0 to 5:
- ECOG 0: Fully active
- ECOG 1: Restricted in physically strenuous activity but ambulatory
- ECOG 2: Ambulatory and capable of self-care but unable to work; up and about >50% of waking hours
- ECOG 3: Capable of only limited self-care; confined to bed or chair >50% of waking hours
- ECOG 4: Completely disabled; cannot carry out any self-care; totally confined to bed or chair
- ECOG 5: Dead
Assessment Rationale
In this case, the key factors determining the ECOG score are:
Bedridden status: The patient is described as bedridden due to an old CVA (cerebrovascular accident), indicating total confinement to bed.
GCS score of 15/15: This indicates the patient is fully alert and oriented with:
- Eye opening: 4 (spontaneous)
- Verbal response: 5 (oriented)
- Motor response: 6 (obeys commands)
Despite the patient's intact cognitive function (GCS 15/15), the defining factor for ECOG scoring is the physical functional status 1. The patient's bedridden condition due to previous stroke indicates they are "totally confined to bed," which is the defining characteristic of ECOG 4.
Important Considerations
Cognitive vs. Physical Function: While the GCS score of 15/15 indicates intact cognitive function, the ECOG scale primarily assesses physical functional status and ability to perform activities of daily living 2.
Assistive Devices: Even if the patient uses assistive devices or modifications to perform some activities, these are not typically incorporated into ECOG scoring determinations 2.
Clinical Implications: An ECOG score of 4 has significant implications for treatment decisions, particularly in oncology settings, as it indicates poor performance status that may limit certain therapeutic options.
Potential Pitfalls in ECOG Assessment
Inter-observer Variability: Studies have shown only moderate agreement between observers when assigning ECOG scores, with a kappa statistic of 0.44 overall 1. However, agreement is higher (probability of 0.82) when determining if a patient falls into the PS 3-4 category versus PS 0-2.
Cognitive Status vs. Mobility: Do not confuse a good cognitive status (GCS 15/15) with good physical functioning. A patient can be fully alert and oriented yet completely disabled physically.
Recent Changes in Status: Patients with recent changes in functional status may be more difficult to categorize accurately 2.
The patient's bedridden status due to previous CVA clearly places them in the ECOG 4 category, despite their intact cognitive function as evidenced by the GCS score of 15/15.