Hepatic encephalopathy

West-Haven Criteria for Hepatic Encephalopathy (HE)

In order to accurately capture the severity of illness for patients with  hepatic encephalopathy, use the West-Haven grading system. The system is detailed here: 

 

Stage	Consciousness	Intellect and Behavior	Neurologic Findings
0	Normal	Normal	Normal examination; if impaired psychomotor testing, consider MHE
1	Mild lack of awareness	Shortened attention span	Impaired addition or subtraction; mild asterixis or tremor
2	Lethargic	Disoriented; Inappropriate behavior	Obvious asterixis; Slurred speech
3	Somnolent but arousable	Gross disorientation; Bizarre behavior	Muscular rigidity and clonus; Hyperreflexia
4	Coma	Coma	Decerebrate posturing