TIMI

The TIMI Score (Thrombolysis in Myocardial Infarction) estimates the likelihood of ischaemic events or mortality in patients with unstable angina and non-ST elevation MI. This can be calculated and reported on a standard laboratory report.

Seven factors are used to calculate mortality risk and risk of other adverse cardiac events:

  • 65 years or older
  • Presence of at least three risk factors for coronary artery disease (diabetes mellitus, hypertension, hyperlipidaemia, smoking, family history)
  • Previous history of coronary stenosis of 50% or more
  • Presence of greater ≥ 2 episodes of angina 24 hours prior to the presentation
  • Aspirin use in the past seven days
  • ST-segment deviations ≥ to 0.05 mV on initial ECG
  • Elevated serum cardiac markers of necrosis

If present, each factor contributes a value of one point toward the TIMI risk score.  A higher score indicates a higher likelihood of adverse cardiac events and/or risk of mortality.  The % risk of mortality, new/recurrent MI, or severe ischemia requiring further invasive cardiac intervention can be predicted as follows:

Low risk Intermediate risk High risk
4.7% for a score of 0/1 13.2% for a score of 3 26.2% for a score of 5
8.3% for a score of 2 19.9% for a score of 4 40.9% for a score of 6/7

SOFA

SOFA Score: (Sequential organ failure assessment) predicts mortality in critically ill patients.

This can be calculated and reported on a standard laboratory report.

SOFA score on admission has shown a strong correlation with the outcome, and can help triage patients.

There is a good correlation between increasing SOFA score and mortality in acutely ill ICU patients.

The SOFA score is the sum of 6 different organ scores, one each for respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems. Each system can get a score of 0 to 4 where an increasing score indicates worsening organ dysfunction.

The following clinical or laboratory parameters are used in the calculation:

  • Respiratory: PaO2/FiO2 (Arterial blood gas)
  • Coagulation: Platelet count
  • Liver: Total Bilirubin concentration
  • Cardiovascular: Mean arterial pressure, vasopressors
  • Central nervous system: Glasgow coma score
  • Renal: Serum Creatinine

The SOFA score is calculated and displayed graphically (cumulative) on the patient laboratory report:

 

WELL’S

Well’s Score: risk stratification of patients with possible pulmonary embolism and estimation of pre-test probability. This can be calculated and reported on a standard laboratory report.

The Wells score for DVT is the best known clinical probability assessment tool for clinically suspected Deep Vein Thrombosis. It is a simple scoring system with a maximum of eight score points, with one point each given for

Well’s score : DVT Factor Points
Cancer 1
Paralysis or recent plaster cast 1
Bed rest longer than 3 days or surgery in the previous 4 weeks 1
Pain on palpation of deep veins 1
Swelling of the entire leg 1
An affected calf more than 3 cm larger in diameter than the unaffected calf 1
Pitting oedema of affected side 1
Dilated superficial veins 1
2 points are subtracted if an alternative diagnosis is at least as probable as DVT.

Low probability = 0 points,  Intermediate clinical probability = 1 – 2 point,  High probability ≥ 3 points

 

Well’s Score: Pulmonary embolism Factor Points
Clinical symptoms of DVT (leg swelling, pain with palpation) 3.0
Other diagnosis less likely than pulmonary embolism 3.0
Heart rate > 100 1.5
Immobilization (≥ 3 days) or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1.0
Malignancy 1.0
Traditional clinical probability (Well’s criteria) Simplified clinical probability (Modified Well’s criteria)
High >6.0 PE likely >4.0
Moderate 2.0 – 6.0 PE unlikely ≤ 4.0
Low <2.0