Disease-specific scoring systems may be more useful in assessing mortality rates (the CURB-65 score again contains both acute and chronic elements in its assessment process) than the severity of acute illness.Likewise, subjective visual assessments– while valuable in recognising ill health– may not distinguish between acute and chronic elements of the disease process. For example, the pale complexion of a patient with cool peripheries may suggest a spectrum of possible diseases from chronic anaemia to acute MI.Consequently, a review of patients’ acute problems may not lead to appropriate intervention. Such assessments need to be viewed in the context of co-morbidities or pre-admission health status (NICE, 2007).GrADING chroNIc ProBlemSAs with acute illness severity scores, chronic illness states can be graded by applying nationally or internationally accepted scores/