Clinical Calculator

Alvarado score
UseEvaluate likelihood of appendicitis in adult
ScoringScore: 0 for no
- Migration of pain to right lower quadrant  (1 for yes)
- Anorexia or acetone in urine  (1 for yes)
- Nausea-vomiting  (1 for yes)
- Right lower quadrant tenderness  (2 for yes)
- Rebound pain  (1 for yes)
- Fever  (1 for yes)
- WBC > 10K  (2 for yes)
- Left shift (over 75% neutrophils)  (1 for yes)
Assessment<5:  appendicitis less likely
 5-6: possible appendicitis
7-8: probably appendicitis
>8: very probably appendicitis
.Appendix
ROSIER Tool
UseRule Out Stroke In the Emergency Room
ScoringScore: 0 for no
- Has there been loss of consciousness or syncope?  (-1 for yes)
- Has there been seizure activity?  (-1 for yes)
- Is there a new onset or waking from sleep?
       - asymmetric facial weakness  (1 for yes)
       - asymmetric arm weakness  (1 for yes)
       - asymmetric leg weakness  (1 for yes)
       - speech disturbance  (1 for yes)
       - visual field defect  (1 for yes)
AssessmentIf total score > 0: stroke likely
If less or equals to 0: low probability but cannot exclude
.Stroke
Shock Index
UseEvaluate possibility of acute critical illness
Calculationheart rate/systolic blood pressure
Normal0.5 - 0.7
Significancelow sensitivity
> 0.9: associated with higher risk of morbidity, mortality and admission
.Shock
ABCD2 Score for TIA
UseEstimates risk of stroke after a TIA
ScoringAge >= 60 (+1 if yes)
BP >= 140/90 mmHg at initial evaluation (+1 if yes)

Clinical features of TIA:
  - unilateral weakness (+2 if yes)
  - speech disturbance without weakness (+1 if yes)

Duration of symptoms:
  - 10 - 59 minutes (+1 if yes)
  - >= 60 minutes (+2 if yes)

Diabetes Mellitus present? (+1 if yes)
Assessment  Stroke risk:
     - 0-3: low risk
     - 4-5: moderate risk
     - 6-7: high risk
.Stroke
Well's Criteria for DVT
UseEstimates likelihood of deep vein thrombosis
ScoringActive cancer (ongoing treatment or within previous 6 months or palliative) (+1)

Paralysis, paresis or recent plaster immobilization of the lower extremities (+1)

Recently bedridden for > 3 days, or major surgery within 12 weeks (+1)

Localised tenderness along the distribution of the deep venous system (+1)

Entire leg swollen (+1)

Calf swelling by > 3 cm (measured 10 cm below tibial tuberosity) (+1)

Pitting oedema confined to symptomatic leg (+1)

Collateral superficial veins (non-varicose) (+1)

Previous documented DVT (+1)

Alternative diagnosis at least as likely (-2)
Assessment  Score of 2 or higher — deep vein thrombosis is likely. Consider imaging the leg veins.
Score of less than 2 — deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis
.DVT
Well's Criteria for Pulmonary Embolism
UseEstimates likelihood of pulmonary embolism
Scoringclinically suspected DVT (+3 points)
alternative diagnosis is less likely than PE (+3 points)
tachycardia (+1.5 points)
immobilization/surgery in previous four weeks (+1.5 points)
history of DVT or PE (+1.5 points)
hemoptysis (+1 point)
malignancy (treatment for within 6 months, palliative) (+1 point)
Assessment  Traditional interpretation:
  *  > 6 - High (59% probability)
  * 2 to 6 - Moderate (29% probability)
  * < 2 - Low (15% probability)

Alternative interpretation (used in CGH)
  * > 4 - PE likely. Consider diagnostic imaging. Repeat if scan within 1 week if strong suspicion
  * 4 or less - PE unlikely. Consider D-dimer
Follow up investigations
(+) D-dimer(-) D-dimer
Low pretest probability scoreUrgent scan
If (-), discharge
< 1% risk of DVT.
No scan
.Pulmonary embolism
Bleeding Risk Scoring System
Number of comorbid condns at start of therapyOne (+1)
Two (+2)
Three (+3)
Concomitant use of heparinAge 60-79 yrs  (+2)
Age 80 or more (+4)
INR level2.0 - 2.9     (+1)
3.0 or more (+2)
Worsening liver dysfunction during therapy
(bilirubin rising to 4 mg/dl (68.4 umol/L) or more)
Yes  (+2)
Scoring:- low risk: 0 - 2 points
- moderate risk: 3 - 4 points
- high risk: 5 or more points
.Anticoagulation
HASBLED
UseAssess risk of bleeding in AF
ScoringHypertension  +1
Abnormal renal and liver fn  +1 each
Stroke            +1
Bleeding         +1
Labile INR     +1
Elderly (>65yrs) +1
Drugs or alcohol  +1 each
AssessmentScore > 3 = High risk
.AF, Anticoagulant