The Karnofsky Performance Score (KPS) ranking runs from 100 to 0, where 100 is "perfect" health and 0 is death. Practitioners occasionally assign performance scores in between standard intervals of 10. This scoring system is named after Dr. David A. Karnofsky, who described the scale with Dr. Walter H. Abelmann, Dr. Lloyd F. Craver, and Dr. Joseph H. Burchenal in 1948. The primary purpose of its development was to allow physicians to evaluate a patient's ability to survive chemotherapy for cancer.
100 – Normal; no complaints; no evidence of disease.
90 – Able to carry on normal activity; minor signs or symptoms of disease.
80 – Normal activity with effort; some signs or symptoms of disease.
70 – Cares for self; unable to carry on normal activity or to do active work.
60 – Requires occasional assistance, but is able to care for most of their personal needs.
50 – Requires considerable assistance and frequent medical care.
40 – Disabled; requires special care and assistance.
30 – Severely disabled; hospital admission is indicated although death not imminent.
20 – Very sick; hospital admission necessary; active supportive treatment necessary.
0 – Asymptomatic (Fully active, able to carry on all predisease activities without restriction)
1 – Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
2 – Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
3 – Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)
4 – Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)
5 – Death
Children, who might have more trouble expressing their experienced quality of life, require a somewhat more observational scoring system suggested and validated by Lansky et al. in 1987:
100 – fully active, normal
90 – minor restrictions in strenuous physical activity
80 – active, but gets tired more quickly
70 – greater restriction of play and less time spent in play activity
60 – up and around, but active play minimal; keeps busy by being involved in quieter activities
50 – lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities
40 – mainly in bed; participates in quiet activities
30 – bedbound; needing assistance even for quiet play
20 – sleeping often; play entirely limited to very passive activities
10 – doesn't play; does not get out of bed
0 – unresponsive
A translation between the Zubrod and Karnofsky scales that works especially well for healthy patients has been validated in a large sample of lung cancer patients:
Zubrod 0–1 equals Karnofsky 80–100
Zubrod 2 equals Karnofsky 60–70
Zubrod 3–4 equals Karnofsky 10–50
↑ Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The Use of the Nitrogen Mustards in the Palliative Treatment of Carcinoma – with Particular Reference to Bronchogenic Carcinoma. Cancer. 1948;1(4):634-56.
↑ Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer. 1996 Jun;32A(7):1135-41.