Child CG, Turcotte JG.

Surgery and portal hypertension. In: The liver and portal hypertension.
Edited by CG Child. Philadelphia: Saunders 1964:50-64.

Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R.

"Transection of the oesophagus for bleeding oesophageal varices". Br J Surg. 1973;60(8):646–9.

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I➜In gastroenterology the Child-Pugh Score (also called Child-Turcotte-Pugh score) is used to assess prognosis/mortality in absence of liver transplantation in a cirrhotic patient and hence plan the timing for liver transplantation. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation. The four grades are:
  - Grade 1: Inverted sleep pattern; forgetfulness, agitation, irritability, apraxia
  - Grade 2: Lethargy; Disorientation for time or place, Subtle personality change; Asterixis, ataxia
  - Grade 3: Somnolence but rousability, Disorientation as regards place; Asterixis, hyperactive reflexes, Babinski signs, muscle rigidity
  - Grade 4: Coma (unresponsive to verbal or noxious stimuli)

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