Table 2: The West Haven scale.

Stage The West Haven criteria Adapted West Haven criteria

0 No abnormality detected Alert and attentive (oriented in time and space) without signs of encephalopathy (neither dysarthria, ataxia, flapping tremor, or obvious decrease in the speed of mental processing)

1 Trivial lack of awareness
Euphoria or anxiety
Shortened attention span
Impairment performance of addition
Alert and attentive, but with at least one of the following signs: dysarthria, ataxia, flapping tremor, or obvious decrease in the speed of mental processing

2 Lethargy or apathy
Minimal disorientation for time or place
Subtle personality change
Inappropriate behavior
Impaired performance of subtraction
Awake but inattentive: disoriented, somnolent, easy to distract, and unable to perform easy mental tests (addition, subtraction, and remember a list of numbers)
Patient’s speech is easy to understand

3 Somnolence to semistupor but responsive to verbal stimuli
Confusion
Gross disorientation
Marked somnolence or psychomotor agitation
Speech is difficult to understand

4 Coma (unresponsive to verbal or noxious stimuli)Coma
The patient does not speak and does not follow simple commands (such as raising an arm or opening the mouth)