CRASH Score — Chemotherapy Risk Assessment Scale for High-Age
Stratifies risk of severe chemotherapy toxicity in adults ≥70 (Extermann 2012). Combines patient factors (haemoglobin, creatinine clearance, IADL, MMSE/MNA, ECOG, LDH) + chemotherapy regimen toxicity. Use the band closest to your calculated score.
Score interpretation
→ Standard chemotherapy regimen and dosing.
→ Standard regimen with proactive monitoring; consider G-CSF prophylaxis in regimens with ≥10–20% febrile neutropenia risk.
→ Discuss dose reduction; G-CSF prophylaxis; closer monitoring; consider less toxic alternative regimen if available; CGA-led optimisation pre-chemo.
→ Strong consideration of dose reduction (commonly 25–30%) or alternative less-toxic regimen. Engage palliative care for symptom support. Frequent (weekly) clinical review during initial cycles. Patient and family discussion on goals and trade-offs.
Interpretation bands for the CRASH. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Hydroxocobalamin (High-Dose — Cyanide Antidote) · Cyanide Antidote (Vitamin B12 Precursor at High Dose)
- Thiamine (IV/IM — Pabrinex) · Vitamin B1 (Thiamine) — deficiency treatment / Wernicke's encephalopathy prevention
- Folinic Acid (Calcium Folinate / Leucovorin) · Antidote / Chemotherapy Support
- Calcium chloride · IV calcium salt (high elemental calcium)
- Zoledronic Acid · Bisphosphonate (IV)
- Falls Assessment in Older Adults · NICE CG161 2013
- Anaemia Investigation · BSH / NICE
- Lower Respiratory Tract Infection (Primary Care) · NICE NG138 / NICE antimicrobial guidance
- Hypertension Management · NICE NG136 2019
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.