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 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 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|
|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|
|Traditional clinical probability (Well’s criteria)||Simplified clinical probability (Modified Well’s criteria)|
|Moderate||2.0 – 6.0||PE unlikely||≤ 4.0|