Scoring Systems Flashcards
Describe use, parameters and interpretation of HAS BLED score
Use to assess bleeding risk for AF anticoagulant treatment
Superseded by ORBIT score (NICE recommends)
Parameters - 1 point for each
- HTN
- renal disease
- liver disease
- stroke hx
- prior major bleeding or predisposition to bleeding
- labile INR
- 65+
- other medication that predisposes to bleeding
- alcohol use over 8 units a week
1 and below can give
2 consider
3+ is high risk of bleeding
Wells score for DVT
- Low risk is < 2 - D-dimer
- higher needs USS within 4 hours
- Active cancer (Tx ongoing, within 6 months or palliative)
- Paralysis, paresis or plaster immobilisation of lower extremities
- bedridden > 3 days, or major surgery in last 3/12
- Localised tenderness deep vein system
- Entire leg swollen
- Calf swelling > 3cm
- unilateral pitting oedema
- Collateral superficial veins (non-varicose)
- Previous DVT
- - 2 An alternative dx as likely as DVT
GCS scoring adults
Eye opening scores
- 4: Spontaneously
- 3: To verbal command
- 2: To pain
- 1: No response
Best motor response scores
- 6: Obeys command
- 5: Localizes pain
- 4: Flexion withdrawal
- 3: Flexion abnormal (decorticate)
- 2: Extension (decerebrate)
- 1: No response
Best verbal response scores
- 5: Oriented and converses
- 4: Disoriented and converses
- 3: Inappropriate words; cries
- 2: Incomprehensible sounds
- 1: No response
13-15 - mild
9-12 - moderate
< 8 severe
CHADsVASc score
- Males scoring > 1 or females score > 2 should be anticoagulated
CHADSVASc
Points
C
Congestive cardiac failure
1
H
hypertension
1
A2
> 75 years old
2
D
Diabetes mellitus
1
S2
Previous stroke or TIA
2
V
Known vascular disease
1
A
Aged 65-74
1
Sc
Female
1
ORBIT score
assessing bleeding risk in AF
ORBIT
Points
Sex
Haemoglobin (F < 12, M < 13)
2
Age > 74
1
Bleeding history
2
Renal function eGFR < 60
1
Concomitant use of anti-platelets
1
Fontaine classification for peripheral arterial disease
-
Fontaine classification
- I - asymptomatic, II - intermittent claudication, III - rest pain, IV - tissue loss/gangrene
Jones criteria
Jones criteria - rheumatic feveer
Diagnosis requires - evidence of strep. Infection + 2 major or 1 major + 2 minor
- Evidence of recent streptococcal infection
- Hx of scarlet fever, +ve throat swab, ↑ ASOT > 200 U/ml or Dnase B titre
- Major criteria
- Arthritis
- Pancarditis
- Sydenham’s chorea
- Erythema marginatum
- Subcutaneous nodules
- Minor criteria
- Fever
- Arthralgia - unless arthritis met as major
- ↑ acute phase proteins (ESR, CRP)
- Prolonged PR interval on ECG - except if carditis meets major criteria
Duke’s criteria
duke’s criteria - infective endocarditis
Diagnoses: 2 major or 1 major + 3 minor or 5 minor
Major
Minor
- Persistent bacteraemia (> 2 +ve blood culture, 12 hours apart)
- Echocardiogram findings - vegetations seen
- +ve serology for bartonella, coxiella, brucella
- Predisposing RF - murmur, IVDU, etc
- Fever > 38 or high CRP
- Evidence of immune complex formation - splinter haemorrhages, haematuria
- Vascular phenomena - major arterial emboli (stroke, PE)
- Positive echo that doesn’t meet the major criteria
Parkland’s formula
fluids for firsr 24 hours in burns
-
Modified parkland formula - used for directing fluid requirements, volume of crystalloid fluid to be given in first 24 hours
- Adults - 4mL (Hartmann’s) x weight (kg) x % TBSA burned
- Children - 3mL (Hartmann’s) x weight (kg) x % TBSA burned
- Give 50% calculated in 8 hours post burn and 50% in remaining 16 hours
stages of CKD
- Stage 1: GFR _>_90mL/minute/1.73m2 with other evidence of CKD e.g. sediment, structure
- Stage 2: GFR 60-89 mL/min/1.73m2 with other evidence of CKD
- Stage 3a: moderate, GFR 45-59 mL/min/1.73m2
- stage 3b: moderate, GFR 30-44 mL/min/1.73m2
- stage 4: severe, GFR 15-29 mL/min/1.73m2
- stage 5: established renal failure, GFR < 15 mL/min/1.73m2 or on dialysis
stroke scoring triage assessment A&E - ROSIER
-
ROSIER score - to be used to triage patient’s on presentation to assess likelihood of stroke
- Stoke is likely if scoring > 0
- Exclude hypoglycaemia first
- Assessment:
- -1 point - loss of consciousness/syncope; seizure activity
- +1 point - asymmetric face weakness, asymmetric arm weakness, asymmetric leg weakness, speech disturbance, visual field defect
Glasgow score
for pancreatitis
-
Modified Glasgow criteria - severity scoring for acute pancreatitis, to be completed within 48 hours
- Any patient > 3 in first 48 hours → severe, HDU/ITU referral
-
Mnemonic (pancreas)
- PaO2 < 8kPa on ABG
- Age > 55 years
- Neutrophilia – WBC > 15x 109/L
- Calcium <2mmol/L
- Renal function – urea >16mmol/L
- Enzymes – LDH >600iu/L or AST > 200 iu/L
- Albumin < 32 g/L (serum)
- Sugar – blood glucose > 10mmol/L
scoring for Upper GI bleed pre-endoscopy
Glasgow-BLATCHFORD score
used to risk stratify patient admitted with upper GI bleed
- > 6 associated with >50% risk of needing an intervention
- NICE if > 0 - IP OGD, if 0 - OP OGD
- the parameters:
- urea
- Hb
- systolic BP
- pulse (bpm)
- melaena
- syncope
- known liver failure
- known cardiac failure
scoring for upper GI bleed
rockall score
- assess mortality
- pre-endoscopy out of 7, post-endoscopy our of 11
- NICE prefers blatchford for pre-Ix determination of timing for OGD
- if > 0 should have inpatient OGD, if 0 - urgent OP OGD
- factors:
- age
- SBP
- comorbidities - IHD/cardiac failure, liver failure, renal failure, metastases
- endoscopy dx - Mallow weiss, all other, GI malignancy
- at endoscopy - no blood or dark red spot or blood in upper GI tract (spurt, adherent clot)
GCS core components and overall maximum marks
out of 15
M - 6
S - 5
E - 4
