Clinical scoring systems Flashcards
What scoring systems can be used to asses GI bleeding?
Rockall score and the Blatchford score
What is Rockall score used for?
To predict the risk of death and risk of re-bleeding from an upper GI bleed
In other words - determines the severity of GI bleed.
What parameters are involved in Rockall scoring system?
Age, Shock, co-morbidities, diagnosis, major stigmata of recent haemorrhage.
What is required to use the Rockall scoring system?
Need endoscopy findings
What is Blatchford scoring system used for?
Will predict the need for intervention i.e blood transfusion or therapeutic endoscopy. Used to help decide if a patient needs admitting to hospital or not.
What is MELD scoring system used for?
MELD = Model for End stage Liver Disease.
Used for patients with liver cirrhosis - ranks degree of illness to determine how urgently you will receive a donor liver/transplant procedure
Used to monitor complications in patients with cirrhosis.
What is Maddrey’s score used for?
(Maddrey’s score is aka Maddrey’s disciminant function)
Predicts prognosis in alcohol-related hepatitis and identify patients suitable for treatment with steroids.
What is (Modified) Glasgow score used to assess?
Severity of pancreatitis
Describe criteria for Glasgow imrie score
Use PANCREAS
P - PaO2
A - Age >55
N - Neutrophils (WBC>15)
C - Calcium <2
R - uRea >16
E - Enzymes (LDH>600 or AST/ALT>200)
A - Albumin <32
S - Sugar (Glucose >10)
Describe Glasgow coma scale score
Eye opening:
4 - spontaneously
3 - to speech
2 - to pain
1 - no response
Verbal response
5 - orientated to time, person, place
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response
Motor response
6 - obeys command
5 - moves to localised pain
4 - flex to withdraw from pain
3 - abnormal flexion
2 - abnormal extension
1 - no response
Describe CURB-65 scoring system
Confusion
Urea >7mmol
Resp rate >30
Blood pressure <90 systolic
Over 65
CURB-65 score of 2+ = admit.
Describe Centor scoring system
Estimates probability that pharyngitis is streptococcal and suggests management course
Only to be used in patients with ≤3 day Hx of pharyngitis
Age
- 3-14yrs = 1 point
- 15-44 = 0 points
- 45+ = -1 point
Exudate or swelling on tonsils = yes (1 point) or no
Tender/swollen anterior cervical LN = Y/N
Temp >38C = Y/N
Cough = Present (0)/ absent (+1 point)
Describe FeverPAIN scoring system
Predicts likelihood of strep throat Yes = 1 point. No= 0 point. Total of 4+ points = abx. 2-4 points = delay abx script. 0-2 points = Strep throat unlikely
Questions asked:
Fever in past 24hrs
Absence of cough or coryza
Symptom onset ≤3 days
Purulent tonsils
Severe tonsil inflammation
Describe CHA2DS2-VASc
Estimates stroke risk in pts with AFib
Congestive Heart failure
Hypertension
Age (1 point 65-74, 2 points 75+)
Diabetes
Stroke or TIA recently
Vascular disease
Sex category - female
Score above 1 = high risk
Score of 1 = moderate risk
Describe BTS classification of asthma severity
Mild:
- no features severe asthma
- PEFR >75%
Moderate:
- no features of severe asthma
- PEFR 50-75%
Severe: if one of following present:
- Can’t complete sentences in one breath
- PEFR 33-50%
- RR >25
HR >110/min
Life threatening: if any one of following present:
- PEFR<33%
- Sats <92% or ABG pO2 <8kPa
- Cyanosis, poor respects effort, near or fully silent chest
- exhaustion, confusion, hypotension, arythmies
- normal pCO2
Near fatal:
- raised pCO2
Describe MRC dyspnoea score
Grade of breathlessness related to activities.
Used in rest diseases, especially COPD
1 = not troubled by breathlessness expect on strenuous activity
2 = SOB when hurrying or walking up a slight hill
3 = walks slower than contemporaries on ground level
4 = stops for breath after walking about 100m or after a few mins on level ground
5 = too breathless to leave house, breathless on dressing/undressing
Describe CKD classification
Stage 1 = eGFR >90
Stage 2 = 60-89
Stage 3a = 45-59
Stage 3b = 30-44
Stage 4 = 15-29
Stage 5 = eGFR <15
Describe MRC grading of muscular power
0 = no contraction
1 = flicker or trace of contraction
2 = active movement, with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and resistance
5 = normal power
What are parameters in Wells score?
- Signs and symptoms of DVT
- PE is number 1 Ddx
- HR >100
- Haemoptysis
- Immobilisation in 3+ days or surgery in last 4 weeks
- Previous DVT, VTE, PE
- Malignancy with treatment within last 6 months or palliative
What is ASA used for?
Classifies health of patients prior to surgery
What is HAS-BLED used for?
Estimates risk of major bleeding for patients on anti-coag to assess risk-benefit in A.fib care
What is Rockall used for?
Determines severity of GI bleeding, prior to endoscopy
What is POSSUM used for?
Estimates morbidity and mortality for general surgery patients
What is NELA used for?
Estimates risk of death within 30 days of emergency abdominal surgery
What is Ranson used for?
Estimates mortality of patients with pancreatitis, based on initial and 48hr lab values
What is ROME used for?
Criteria to diagnose IBS
What is PHQ-9 used for?
Patient health questionnaire-9.
Used for degree of depression severity.
What is GAD-7 used for?
Generalised Anxiety Disorder.
Measures severity of anxiety
What is FAST used for?
There are a few..
FAST for alcohol screening test
FAST acronym for stroke
FAST focused assessment with sonography for trauma - predicts presence of pericardial or intra-ado injury after penetrating or blunt trauma
What is GPCOG used for?
GP assessment of cognition
A screening tool for dementia
What is STaRTBack used for?
Used to categorise patients into low, medium and high risk for back pain. Helps decision making and management of patient
