Clinical Condition Scores Flashcards
Modified Duke’s Criteria
Modified Duke’s Criteria for Infective Endocarditis
Pathological Criteria (if either positive, diagnosis of IE is definitive) = Micro-organisms in a vegetation OR pathological lesions
Major Clinical Criteria (if both are positive, diagnosis of IE is definitive) = Blood cultures positive for IE (typical organisms from 2 separate cultures or single positive for Coxiella Burnetii) AND Evidence of Endocardial Involvement (NEW echo signs)
Minor Clinical Criteria (if all are positive, diagnosis of IE is definitive) = Predisposing heart condition or IVDU AND Fever AND Vascular phenomena AND Immunologic phenomena AND Microbiological evidence
Possible IE = 1 major + 1 minor OR 3 minor - exercise clinical judgement
CPIS Score
Clinical Pulmonary Infection Score (CPIS) for Ventilator Associated Pneumonia (VAP)
A score of >=7 may indicate higher likelihood of VAP
Temperature WCC Tracheal Secretions PaO2/FiO2 CXR Culture of tracheal aspirate specimen
SOFA Score
The Sequential Organ Failure Assessment score SOFA incorporates the physiological derangement of six organ systems, where each organ system is given a score between 0 (normal function) and 4 (grossly abnormal) to give an overall score of 24. The worst value over 24 h is recorded.
An increase in SOFA score by 2 was associated with an approximate 10% increased mortality risk.
Variables are:
- Lowest PAO2/FIO2 ratio
- Platelets
- Highest bilirubin
- BP status
- GCS
- Highest creatinine concentration
- Total urine output
MELD Score
The MELD score is used to predict short term survival in cirrhosis patients and the urgency of need for liver transplantation.
It comprises bilirubin, INR and creatinine.
Lille Model
The Lille Model is used to predict 6 month survival in patients with alcoholic hepatitis.
Glasgow Alcoholic Hepatitis Score
The Glasgow Alcoholic Hepatitis Score is used to predict 28-day mortality (score >9) and is comprised of 5 variables - age, WCC, urea, INR and bilirubin
Child-Pugh Score
The Child-Pugh Score is used in chronic liver failure to prognosticate in patients with cirrhosis. It is ranked A to C predicting mortality at 1 year and comprises 5 variables - encephalopathy, ascites, bilirubin, albumin and PT
APACHE II
3 factors: Acute physiological score (comprising clinical and biochemical parameters), age, and previous health conditions
12 Acute physiological parameters includes: Rectal temperature, MAP, HR, RR, Alveolar/arterial gradient, Arterial pH, Serum sodium, potassium and creatinine, Haematocrit, leukocyte count and GCS.
Worst score in first 24h after ICU admission
Score 25 = 50% predicted mortality; >35 = 80%
What are the King’s College selection criteria for paracetamol toxicity?
1. pH <7.3 Or 2. All three of: INR >6.5/ PT >100 Serum Cr >300 Grade 3 or 4 hepatic encephalopathy
What are the King’s College selection criteria for Non-paracetamol induced ALF?
1. INR >6.5 Or 2. Any three of i. Age <11 or >40 ii. Aetiology non-A,B or drug reaction iii. Time from onset of jaundice to encephalopathy >7days (i.e. not hyper acute) iv. Serum bilirubin >300
West Haven (grading of encephalopathy)
0 = sub clinical 1= Trivial lack of awareness eurphoria or anxiety, shortened attention span, impaired performance 2 = Lethargy or apathy, disorientation in time, personality change, inappropriate behaviour 3 = Somnolence to semi-stupor, confusion, gross disorientation 4 = Unresponsive to verbal stimulus
O’ Grady Classification for ALF
Hyper-acute = <7 days Acute = 7-28 days Sub-acute = 4 weeks - 3 months
How does salicylate poisoning present?
Fever Tinnitus Hypoglycaemia Vertigo Visual disturbance Coagulopathy Pulmonary oedema Vomiting (activates CTZ) Respiratory alkalosis
What scoring system is used to prognosticate in ruptured AAA?
Hardman Index
Age >76 Creatinine >190 Haemoglobin <90 Myocardial ischemia on ECG H/O LOC
KDIGO Criteria for AKI
Stage 1 = >1.5x increase in Cr + <0.5ml/h UO for 6-12h
Stage 2 = >2x increase in Cr + <0.5ml/h UO for >12h
Stage 3 = >3x increase in Cr + Anuria for >12h
