What does ++ mean in medical terms?: Understanding Severity Shorthand

September 29, 2025 •

5 min read

According to medical education resources, a single plus sign (+) in a medical chart can indicate a finding is 'present,' while additional plus signs like ++ and +++ are often used as nonstandard shorthand to denote a greater degree or severity of that finding. The exact meaning of what does ++ mean in medical terms depends entirely on the clinical context in which it is used.

Quick Summary

This guide explains the different meanings of the ++ symbol in various medical settings, from clinical documentation to lab results and physical exams. It clarifies that this nonstandard notation signals severity or significance, requiring context for proper interpretation.

Key Points

Context is Key: The meaning of ++ in medical terms is highly dependent on the specific clinical context, such as physical exams, lab results, or physician notes.
Informal Severity Grade: Multiple plus signs (++, +++) are often used as an informal, non-standard shorthand to indicate a higher degree or severity of a finding.
Not a Diagnosis: A plus sign is a observation, not a diagnosis. A 'positive' lab result (e.g., ++) requires further professional interpretation and testing.
Chemical vs. Clinical: In a biochemical context, Ca++ specifically denotes the calcium ion's charge, not a clinical finding. It is distinct from the informal grading system.
Professional Interpretation Needed: Patients should always seek clarification from their doctor regarding any shorthand like ++ to ensure accurate understanding and avoid misinterpretation.
Contrasts with Formal Systems: The informal plus-sign system differs from standardized grading scales used for things like Severity of Illness (SOI) or evidence quality, which are designed for more objective assessment.
Edema Grading: In physical exams, pitting edema severity is often graded on a 1+ to 4+ scale based on the depth and duration of the indentation.

The Informal Grading System: Context is Everything

In the medical world, abbreviations and symbols are common for efficiency. The use of plus signs, such as ++, is a prime example of this informal medical shorthand. Rather than representing a universal, standardized measurement, the number of plus signs functions as a simple, subjective grading scale to indicate the degree or extent of a particular finding. A single plus (+) often means a finding is present or positive, while multiple pluses (++ or +++) suggest the finding is more significant, intense, or severe. Because this system is not standardized, healthcare providers and patients must understand the context to interpret it correctly. A finding noted as '++' in a patient's chart could mean something completely different than a '++' result on a lab report. This informal scale is contrasted by formal, standardized systems designed for precision.

Where You Might See Plus Signs

Plus signs appear in various parts of a patient's medical record, each with a distinct contextual meaning.

Clinical Notes and Charting: In a physician's or nurse's notes, plus signs are used to document the severity of a symptom. For example, 'cough++' might be documented for a severe cough, whereas a 'cough+' might be a milder one. The shorthand allows for quick, concise communication between healthcare staff, though it lacks the detail of a formal description.
Laboratory and Pathology Reports: A plus sign on a lab result can indicate a positive or abnormal finding. For instance, a urinalysis might show a 'glucose++' result, indicating a significant amount of glucose in the urine. In pathology reports, a positive (+) margin indicates that cancer cells were found at the edge of the removed tissue, suggesting that not all of the cancer may have been excised. The number of plus signs can sometimes be used to quantify the amount of a substance found.
Physical Examinations: When a clinician performs a physical exam, they may use plus signs to grade the severity of a physical sign. A classic example is pitting edema, or swelling, which is graded on a scale from +1 to +4. The grading is based on the depth of the indentation left after applying pressure and how long it takes for the skin to rebound. Similarly, peripheral pulses are sometimes graded on a 0 to 2+ scale, with 2+ being a normal pulse.
Chemical Notation: In a biochemical context, plus signs are used in standard chemical notation to indicate an ion's charge. For example, 'Ca++' or 'Ca+2' refers to the calcium ion. This is not shorthand but a scientific convention that denotes the ion's positive charge, not its clinical significance. It's an important distinction that patients should be aware of when reviewing lab results.

Formal vs. Informal Medical Grading

To highlight the difference between informal notation and standardized practice, consider this comparison table. It illustrates why relying solely on plus signs for interpretation can be misleading.


Feature	Informal Plus-Sign Notation (++, +++)	Standardized Clinical Grading (e.g., Edema Grading)
Objectivity	Highly subjective; relies on the individual's assessment of severity.	Standardized criteria exist, such as measuring depression depth for edema.
Consistency	Varies widely between providers, institutions, and even different departments.	Improves consistency and reliability through established definitions.
Purpose	Quick, practical charting for internal communication.	Consistent, accurate documentation for research, reporting, and patient outcomes.
Training	Learned through on-the-job training and local conventions.	Formal part of medical education and training.

Why Communication with Your Doctor is Critical

Given the informal and subjective nature of using plus signs, patients should never attempt to self-diagnose or draw definitive conclusions from seeing this shorthand in their medical records. While the intention is to provide a quick summary for other healthcare professionals, the context and nuances are lost to the layperson. Factors such as the specific department, the individual provider's habits, and the type of finding all play a role in interpretation. For example, a '++' for ankle edema might be a relatively common finding, whereas a '++' for a certain type of cancer cell in a pathology report would be a very serious finding. A positive test result on its own isn't enough; further testing is often required to confirm a diagnosis. A patient should always ask for clarification from their healthcare provider to fully understand what a test result or medical note means for their personal health.

Conclusion

In medical terms, what does ++ mean is a question with no single answer, as the symbol's meaning is highly context-dependent and typically serves as a non-standardized shorthand for severity or quantity. From indicating the intensity of a symptom in a patient's chart to grading pitting edema or signaling a positive finding on a lab report, the interpretation requires a professional understanding of the specific clinical area. While this quick documentation tool is useful for healthcare providers, it highlights the need for clear communication between patients and their doctors to ensure accurate understanding and proper follow-up.

What do plus signs signify in clinical practice?

Plus signs primarily act as a quick, non-standard grading system to indicate the degree or severity of a finding. In contrast, standardized systems offer more objective, consistent measurements.

Is seeing '++' on a lab report a cause for alarm?

Not necessarily. A '++' on a lab report simply means a finding was significant or positive. A doctor must interpret this within the context of your overall health and other tests, as it doesn't provide a complete diagnosis on its own.

Can I interpret '++' on my own medical chart?

No, it is highly inadvisable to interpret this shorthand on your own. It is an informal tool for healthcare professionals and its meaning depends on specific clinical context. Always ask your doctor or a member of your care team for clarification.

Does 'Ca++' mean there is a problem with my calcium levels?

No, 'Ca++' is standard chemical notation for the calcium ion and does not inherently indicate an abnormal level. Your doctor will interpret the numeric value next to this notation to determine if your calcium levels are within a healthy range.

Why isn't a standardized system used everywhere?

Informal shorthand like plus signs is often quicker for fast-paced charting, especially for symptoms and physical signs that might not have a formalized scale. However, standardized systems are favored for accuracy in diagnoses, billing, and research.

What does 'pitting edema ++' mean?

It means you have pitting edema (swelling that leaves an indentation when pressed) of a moderate severity. Edema is typically graded on a 1+ to 4+ scale based on the depth and duration of the indentation.

Where can I get reliable information about my test results?

The most reliable information will come from your healthcare provider. Websites like MedlinePlus and the National Cancer Institute provide general information but cannot interpret your specific results.

Frequently Asked Questions

A single plus sign (+) in a medical report usually indicates that a specific finding is 'present' or 'positive'. For example, in pathology, a 'positive margin' means cancer cells were found at the edge of the removed tissue.

Pitting edema is typically graded on a scale from +1 to +4, with the number of pluses indicating the severity. The grading is determined by pressing on the affected area and measuring the depth and time of the rebound.

Not a standardized one. In clinical notes, 'cough++' is an informal shorthand used by staff to indicate that a cough is significant or severe, relative to other findings. It is not a precise, measured value.

Some lab tests, especially for qualitative findings like the presence of certain cells, might use plus signs to indicate quantity. Other tests for substances like calcium (Ca++) provide a precise numeric value to indicate the level. The format depends on what is being measured.

Yes, absolutely. The meaning of ++ is highly context-dependent. A '++' for pitting edema is a moderate level of swelling, while a '++' on a strep test simply means the test was positive for strep bacteria. You should always ask your doctor for specifics.

Yes. Since plus signs are not a standardized system, there is a risk of misinterpretation, particularly for patients reviewing their own charts without a doctor's explanation. This is why standardized systems exist for more critical metrics.

You should ask for a clear, concise explanation. For example, 'I see this result says ++. What does that mean for my specific condition, and what are the next steps?'.