Scoring Systems Flashcards
Ranson Criteria
Scoring system to predict mortality from pancreatitis:
On admission
- WCC > 16
- Age > 55
- Glucose > 10mmol/L
- AST > 250
- LDH > 350
After 48hrs
- Hct drop > 10%
- BUN increase > 5mg/dL
- Ca < 2mmol/L
- arterial pO2 < 60mmHg
- base deficit > 4
- fluid needs > 6L
< 2 signs 5% mortality risk
3-4 signs 15-20% mortality risk
5-6 signs 40% mortality risk
>7 signs 99% mortality risk
Glasgow-Blatchford score
Risk stratifies need for admission in UGI bleeding:
Blood urea Hb (different value for men vs women) Systolic BP Pulse > 100 History and comorbidities - malaena - syncope - hepatic disease - cardiac failure
Score from 0-23
Score of 0 = low risk for needing intervention
Any score higher than 0 suggests high risk for needing intervention, transfusion, endoscopy or surgery.
Rockall score
Risk of re-bleed or death in UGI Bleed.
Comprises pre and post endoscopy findings:
A: age > 60, 60-79, > 80 (score 0-2)
B: BP and PR (shock) BP > 100 PR < 100, BP > 100 PR > 100, BP < 100 (score 0-2)
C: co-morbidities - CHF, IHD, any major comorbidity (2 points), renal failure, liver failure, metastatic ca (3 points)
Post-endoscopy
D: diagnosis - Mallory weis tear or nothing, all other diagnoses, malignancy (score 0-2)
E: endoscopic findings 0-2
Score of 0 at low risk of re-bleeding and death
AIMS65 score
Determines risk of in-hospital mortality from UGI bleeding
A: Albumin < 3 I: INR > 1.5 M: mental status alteration (GCS < 14) S: SBP < 90 65: age > 65
Albumin is the single most predictive factor or mortality.
0-1 = 1% in hospital mortality 2 = 5% 3 = 10% 4 = 16.5% 5 = 25%
Berlin criteria
ARDS diagnostic criteria:
Require criteria:
Bilateral opacities on CXR
Symptoms within 1 week of insult
Respiratory failure not fully explained by cardiac failure/overload
Risk factors:
Risk factors for ARDS (pneumonia, trauma, sepsis)
Objective assessment with ECHO excludes hydrostatic oedema
None
Severity:
Mild: PaO2/FiO2 200-300mmHg with PEEP > 5
Moderate: PaO2/FiO2 100-200 with PEEP > 5
Severe: PaO2/FiO2 < 100 with PEEP > 5
None
Mortality:
Mild 27%
Moderate 32%
Severe 45%
Does not include underlying aetiology and lacks direct measure of lung injury.
Unlikely to affect diagnosis and management.
SMART-COP score
S - systolic BP < 90 M - multilobar A - albumin < 35g/L R - RR > 25 T - tachycardia > 125 C - confusion, new onset O - oxygenation paO2 < 70mmHg sats < 93% P - pH < 7.35
If older than 50yrs
- RR > 30
- oxygenation paO2 < 60 sats < 90%
1-2 low risk IRVS
3-4 moderate risk IRVS
5-6 high risk of IRVS and consider ICU
7+ very high risk IRVS
Risk stratifies need for ICU but does not estimate mortality.
92% sensitivity, 62% specificity
Includes age adjusted cutoffs but age is not a variable like in PSI or CURB-65
PSI score
Risk stratify CAP and indication of mortality.
Risk class I-V
Takes into account age, comorbidities and clinical features.
Includes fever.
Overestimates mortality in older patients and underestimates severity in young and healthy patients.
52% specific (less than CURB 65)
CURB-65
C onfusion U rea > 7 R esp rate > 30 B P < 90 systolic < 60 diastolic 65
Predicts 30 day mortality.
In elderly patients confusion and urea elevation may be due to multiple factors.
No points for co-morbid disease
Equal sensitivity as PSI in predicting mortality but more specific 75%
Modified PESI
Pulmonary embolism severity index
Age > 80
Sats < 90%
Systolic < 100
HR < 110
HEART score
H istory E CG A ge R T roponin
TIMI risk score
Age > 65 > 3 risk factors Known CAD stenosis > 50% ASA use in past 7 days Severe angina > 2 episodes in 24hrs ECG ST change > 0.5mm Positive cardiac markers
Estimates mortality in unstable angina/NSTEMI
0-1 5% risk mortality at 14 days 2 8% risk 3 13% risk 4 20 % risk 5 26% risk 6 41% risk
Modified Glasgow Score
PANCREAS
PaO2 < 60mmHg Age > 55 Neutrophils/WCC > 15 Calcium < 2mmol/L Renal function/Ur > 16 Enzymes/LDH > 600 Albumin < 32g/L Sugar > 10mmol/L
> 3 suggests severe pancreatitis
