Risk Scores Flashcards
General
- Understanding
- Symptoms
- PMH
- Drug history
- Social History
- Risk Score discussion
ABCD² Score
Risk of stroke after TIA
Age ≥60 = 1 point.
BP ≥140/90mmHg = 1 point.
Clinical features;
Unilateral weakness = 2 points.
Speech disturbance without weakness = 1 point.
Duration –
≥60 minutes = 2 points.
10 ≤ minutes < 60 = 1 point.
Diabetes = 1 point.
Could also enquire about atrial fibrillation.
Have they had any other TIAs in the past? How long apart were they?
Score ≤3 = seen within 7 days
Score 4 ≤ score < 6 = specialist within 24 hours
Score >6 = specialist referral immediately
TIA treatment –
Lifestyle advice;
Diet (lower fats and cholesterol).
Exercise more.
Smoking cessation.
Antithrombotic treatment;
300mg aspirin immediately then continued long term 75mg OD.
Clopidogrel 75mg.
Secondary prevention (adherence to medication);
Control HTN.
Statin for patients with high cholesterol.
Carotid endarterectomy if ICA stenosis >70%
DO NOT DRIVE FOR AT LEAST 1 MONTH FOLLOWING A TIA.
CHA₂DS₂-VASc Score
Stroke risk in atrial fibrillation
Congestive heart failure (PMH) = 1 point.
HTN (PMH) = 1 point.
Age (personal information) –
65 ≤ age < 75 = 1 point.
≥75 = 2 points.
Diabetes (PMH) = 1 point.
Stroke/TIA (PMH) = 2 points.
Vascular disease (PMH) = 1 point.
Sex category female (personal information) = 1 point.
Score 0 = no anticoagulation required.
Score 1 = consider anticoagulation with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.
Score 2 or more = anticoagulation required with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban).
Diabetes Risk
Risk of developing diabetes in the next 10 years
Low risk = 0 – 6 points
1 in 100 risk
Increased risk = 7 – 15 points
1 in 35 risk.
Moderate risk = 16 – 24 points
1 in 10 risk.
High risk = 25 – 47 points
1 in 4 risk.
Age, Gender, Ethnicity, Relative with diabetes, waist measurement, BMI (height and weight), HTN
FRAX Score
Gives 10 year probability of a fracture in the spine, hip, shoulder or wrist for people aged 40–90 years old.
T/Z score–
A T-score shows how much your bone density is higher/lower than the bone density of a healthy 30-year old adult. A Z-score compares the condition of your bones with someone of your age/sex/weight/ethnicity.
T–score ≥ –1 = normal bone density, no intervention.
–2.5 < T–score ≤ –1 = osteopenia, consider medication, lifestyle advice
T–score ≤ –2.5 = osteoporosis, medication, lifestyle advice.
Low risk (≤10%, reassess 5y) –
Lifestyle advice;
More weight-bearing exercise, quitting smoking and limiting alcohol.
Calcium + vitamin D rich diet, balance exercises.
Home adaptations;
Getting rid of throw rugs, installing grab bars.
Wearing shoes with good grip.
Intermediate risk (10 < % < 20) –
DEXA scan to measure BMD + if ≤–2.5, Tx with bisphosphonate like alendronate 10mg OD or denosumab (RANK-L), teriparatide.
High risk (≥20%) –
T-score >–2.5 modify risk factors and reassess in 2 years.
T score <–2.5 Tx as above.
QRisk3 Score
Calculates the risk of a person getting a heart attack within the next 10 years in those aged 35-74
Personal information- age, sex, ethnicity, BMI.
PMH (C.A.R.D)- CKD, Atrial fibrillation, Rheumatoid arthritis, diabetic status
DH- antihypertensives
FH- Angina/heart attack in first degree relative <60 years old
SH- smoking status
Direct measurements- cholesterol/HDL ratio, systolic blood pressure
<10% = low risk.
10–20% = moderate risk.
>20% = high risk.
Management <10% –
Advise that risk is low but further reductions in risk can often still be achieved.
Offer advice on relevant lifestyle factors that can be improved –
Stop smoking.
Exercise.
Diet change/weight loss.
Disease control/medication adherence.
Management >10% –
Offer advice on any relevant lifestyle factors to reduce risk.
Consider reviewing any relevant comorbidities that may not be optimally controlled.
Discuss the benefits and risks of taking a lipid modification therapy.
Well’s Score
DVT Risk
History of presenting complaint –
Paralysis, paresis or recent immobilisation of leg = 1 point.
Localised tenderness along the deep venous system = 1 point.
Entire leg swollen = 1 point.
Calf swelling >3cm compared to other leg (measured 10cm below the tibial tuberosity) = 1 point.
Pitting oedema, confined to symptomatic leg = 1 point.
Collateral superficial veins present = 1 point.
Past medical history –
Bedridden recently >3 days or major surgery within 12 weeks = 1 point.
Active cancer (treatment or palliation within 6 months) = 1 point.
Previous DVT = 1 point.
Alternative Dx to DVT as or more likely = –2 points.
Social history can ask about long-haul flights, smoking and HRT/OCP if appropriate.
Score ≤0 = DVT unlikely, 5% prevalence
Score 1–2 = DVT moderate risk, 17% prevalence
Score ≥3 = DVT likely, 17–53% prevalence
Actions
D-dimer is good for a negative exclusion, high specificity, low sensitivity –
If negative then it can be ruled out.
If positive it isn’t diagnostic.
Good if they have a low clinical probability score.
USS doppler veins if high risk.
CTPA is gold standard for diagnosing PE.
DVT treatment
LMWH.
Oral warfarin and maintain INR 2–3 or a DOAC.
Compression stockings.
Treat/seek underlying cause.
Diet, exercise, smoking cessation.
Medications used
Diabetes-
Cardiovascular risk-
Stroke risk-
Osteoporosis-
Stroke after TIA-
DVT-
