Scoring Systems Archives - almostadoctor

PERC score

Dr Tom Leach — Sat, 11 Jul 2020 10:22:18 +0000

The PERC score can be used as a screening tool in patients with a low clinical likelihood of pulmonary embolism – to assess if there is a need for further work-up, or to exclude a diagnosis of PE.

PERC stands for Pulmonary Embolism Rule-out Criteria

A score of ≥1 (i.e. any factor is positive) indicates a positive PERC score and PE cannot be excluded on the basis of PERC score alone in these patients.

The test it typically applied in the emergency department setting for patients in whom PE is an unlikely differential. It may be considered as a adjunct, rather than an alternative to the Well’s score.

Age > 50

HR > 100

O2 sats on room air <95%

Unilateral leg swelling

Use of oestrogen containing medication (e.g. COCP)

Haemoptysis

Recent trauma or surgery (within the last 4 weeks)

Previous PE or DVT

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HAS-BLED score for anticoagulation

Dr Tom Leach — Sat, 11 Jul 2020 09:55:57 +0000

The HAS-BLED tool is often used to assess a patient’s bleeding risk before starting the use of anticoagulation – particularly in relation to atrial fibrillation.
It is often used in conjunction with the CHA₂DS₂-VASc score to weigh the risks and benefits of anticoagulation.
Each item is worth a single point
A score of ≥3 indicates “high risk” for bleeding if anticoagulation is used and it is recommended to either very closely follow-up the patient or consider alternatives to anticoagulation

H	Hypertension >160mmHg systolic
A	Abnormal renal or liver function
S	Previous history of stroke
B	Previous history of major bleeding
L	Labile INR
E	IV drug use (<60% of time in therapeutic range)
D	Drug and alcohol use – NSAIDs, anti-platelet agents, alcohol >8 weeks / week

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Hepatic Encephelopathy

Dr Tom Leach — Sat, 17 Jun 2017 00:12:18 +0000

West Haven criteria for grading hepatic encephalopathy

Grade 1: Trivial lack of awareness. Impaired attention span. Altered sleep, euphoria or depression. Mild asterixis may be present.
Grade 2: Lethargy or apathy. Disorientation. Inappropriate behavior. Slurred speech. Asterixis.
Grade 3: Gross disorientation. Bizarre behavior. Semi-stupor. Asterixis absent.
Grade 4: Coma (unresponsive to verbal or noxious stimuli)

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RIFLE criteria for assessing AKI (Acute Kidney Injury)

Dr Tom Leach — Wed, 14 Jun 2017 14:18:37 +0000

Class	Serum Creatinine/ GFR	Urine Output
Risk	in Serum Creatinine x 1.5 or GFR ¯ >25%	<0.5 ml/kg/hr – more than 6 hours
Injury	in Serum Creatinine x 2 or GFR ¯ >50%	<0.5 ml/kg/hr – more than 12 hours
Failure	in Serum Creatinine x 3 or creatinine > 354mmol/l with an acute rise >44mmol/l GFR ¯ >75%	<0.3 ml/kg/hr – more than 24 hours or anuric for 12 hours
Loss	Persistent acute renal failure with loss of kidney function >4 weeks	–
End-stage kidney disease	ESRD > 3 months	–

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TNM Staging System

Dr Tom Leach — Wed, 14 Jun 2017 13:16:43 +0000

The TNM staging system is used in the evaluation of many cancers. Each individual cancer has its own slight variation on the system, however, it is universally applicable in its basic format.

T: size or direct extent of the primary tumour

Tx: tumor cannot be evaluated
Tis: carcinoma in situ
T0: no signs of tumour
T1, T2, T3, T4: size and/or extension of the primary tumour
- Depending on the cancer, T1-2 typically involve spread within an organ, T3 – spread to the surface of the organ and related structures and T4 involves spread to other adjacent structures or organs.

N: degree of spread to regional lymph nodes

Nx: lymph nodes cannot be evaluated
N0: tumor cells absent from regional lymph nodes
N1: regional lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes)
N2: tumour spread to an extent between N1 and N3 (N2 is not used at all sites)
N3: tumour spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)

M: presence of metastasis

Mx: distant metastasis cannot be evaluated
M0: no distant metastasis
M1: metastasis to distant organs (beyond regional lymph nodes)

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Well’s Score

Dr Tom Leach — Wed, 14 Jun 2017 12:51:59 +0000

Pretest clinical probability scoring for DVT: the Wells score

In patients with symptoms in both legs, use the more symptomatic leg.

Clinical features	Score
Active cancer (treatment within last 6 months or palliative)	1
Paralysis, paresis, or recent plaster immobilisation of leg	1
Major surgery or recently bedridden for >3 days in last 4 weeks	1
Local tenderness along distribution of deep venous system	1
Entire leg swollen	1
Calf swelling >3cm compared to asymptomatic leg (measured 10cm below the tibial tuberosity)	1
Pitting oedema	1
Collateral superficial veins (non-varicose)	1
Alternative diagnosis as likely or more likely than that of DVT	-2

Score:

≥3 points: High probability-treat as suspected DVT or perform compression US.
1-2 points: Intermediate probability-treat as suspected DVT and perform compression US.
≤0 points: Low probability of DVT-perform D-dimer test. If positive D-dimer then treat as suspected DVT and perform compression US. If negative D-dimer, DVT reliably excluded.

Adapted Well’s score for Pulmonary Embolism

Clinical features	Score
Clinical signs and symptoms of Deep Vein Thrombosis	3.0
PE is most likely diagnosis	3.0
Tachycardia (>100 bpm)	1.5
Immobilisation or surgery in the previous 4 weeks	1.5
Previously diagnosed DVT or PE	1.5
Haemoptysis	1.0
Malignancy (treatment within last 6 months or palliative)	1.0

Score:

≥7 points: High probability
2.0-6.0 points: Intermediate probability
0-1 points: Low probability

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MRC Dyspnoea Scale in COPD

Dr Tom Leach — Wed, 14 Jun 2017 11:54:22 +0000

Medical Research Council dyspnoea scale in COPD

1: Not troubles by breathlessness except on strenuous exercise.

2: Short of breath when hurrying or walking up a slight hill.

3: Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace.

4: Stops for breath after about 100, or after a few minutes on the level.

5: Too breathless to leave the house, or breathless when dressing or undressing.

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NYHA Heart Failure Classification

Dr Tom Leach — Wed, 14 Jun 2017 11:34:16 +0000

New York (NYHA) classification of heart failure

Class I (Mild): Heart disease present, but no undue dyspnoea from ordinary activity.
Class II (Mild): Comfortable at rest; dyspnoea on ordinary activities.
Class III (Moderate): Less than ordinary activity causes dyspnoea, which is limiting.
Class IV (Severe): Dyspnoea present at rest; all activity causes discomfort.

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CURB-65 Score

Dr Tom Leach — Tue, 13 Jun 2017 12:56:26 +0000

CURB-65

The severity of community-acquired pneumonia can be assessed by using the CURB-65 score (1 point for each):

Confusion
Urea >7mmol/L
Respiratory rate ≥ 30/min
BP < 90 systolic and/or 60mmHg diastolic
Age ≥ 65

Score:

0-1 home treatment possible
2 hospital therapy
≥ 3 indicates severe pneumonia

Treatments depend on the score, and there are usually local hospital guidelines to follow.

The score can also be used to predict 30-day mortality:
Score

0 – 0.6%
1 – 3.2%
2 – 13%
3 – 17%
4 – 41.5%
5 – 57%

CRB-65

A modified version of the score, known as CRB-65 is often performed in general practice to assess the need for hospital admission. This omits ht urea measurement:

Confusion
Respiratory rate ≥ 30/min
BP < 90 systolic and/or 60mmHg diastolic
Age ≥ 65

In this modified version, a score of 1-2 indicated likely hospital admission, and 3+ indicated urgent hospital admission.

CRB-65 and mortality. Image from Lim WS, van der Eerden MM, Laing R, et al Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study Thorax 2003;58:377-382.

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ASA Physical Status Classification System

Dr Tom Leach — Sun, 11 Jun 2017 07:59:23 +0000

System to assess the fitness of patients before surgery

Status 1: Healthy patient
Status 2: Mild systemic disease
Status 3: Severe systemic disease
Status 4: Severe systemic disease that is a constant threat to life
Status 5: A moribund patient who is not expected to survive without the operation
Status 6: Declared brain-dead patient whose organs are being removed for donor purposes

In an emergency, the physical status classification is indicated with an E after for example “3E”

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