Modification of the Stockholm Vascular Scale

Staging hand-arm vibration syndrome (HAVS) depends upon accurate reporting of the extent and frequency of blanching attacks. Reporting may not be repeatable and not all individuals classifiable using the Stockholm Workshop Scale (SWS). For Department of Trade and Industry (Dti) coal miners' assessments, the SWS was modified to include a blanching score. Further modifications, which involve splitting Stage 2V into 'early' and 'late' have been proposed but the impact of this on classification has not been investigated.

To investigate the impact of modifications in the SWS on HAVS classification.

Staging of individuals with HAVS according to the SWS using two modified scales. Two different cut-offs for defining 'frequent' blanching attacks (>or=3 or >or=7 attacks/week, respectively) were used.

One hundred and sixty-five individuals were staged. Using the SWS, 58 and 31% of the population were unclassifiable using the two cut-offs, respectively. The modification splitting Stage 2V reduced the proportions that were unclassifiable to 2 and 9%, respectively, and increased those classified as Stage 2V. The cut-off for frequent attacks used (3 or 7) affected the proportion of individuals falling into the subdivisions of Stage 2 with 17 and 42% being classified as 2Vearly and 45 and 20% as 2Vlate, respectively.

Subdividing Stage 2V enables more individuals to be classified, but the proportion falling into each category is susceptible to the cut-off used for defining frequent attacks. Caution may need to be applied if this categorization is used to make decisions regarding fitness to work.