Clinical Scoring Systems

In-Shorts

Pulmonary Embolism Rule out Criteria (PERC)

  1. Age greater than or equal to 50 years
  2. Heart rate greater than or equal to 100 beats per minute
  3. Arterial oxygen saturation (SaO2) on room air less than 95%
  4. Venous thromboembolism
  5. Recent (< 28 days) trauma or surgery
  6. Unilateral leg swelling
  7. Hemoptysis
  8. Oral hormone use

Pulmonary embolism workup can be ruled out if

(1) none of the above eight variables is positive and

(2) there is a less than 15% (very low) pretest probability that the patient has a pulmonary embolism.

A PERC evaluation is considered positive if any one of the eight criteria are met.



Ranson criteria

Acute pancreatitis not secondary to gallstones
At admission:

  1. Blood glucose > 11.11 mmol/L (> 200 mg/dL)
  2. Age > 55 years
  3. Serum LDH > 350 IU/L
  4. Serum AST > 250 IU/L
  5. WBC count > 16000 cells/mm3

Within 48 hours:

  1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
  2. Hematocrit decreased by > 10%
  3. Oxygen (hypoxemia with PaO2 < 60 mmHg) BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
  4. Base deficit (negative base excess) > 4 mEq/L
  5. Sequestration of fluids > 6 L
  6. Acute pancreatitis secondary to gallstones


At admission:

  1. Glucose > 220 mg/dl
  2. Age > 70 years
  3. LDH > 400 IU/L
  4. AST > 250 IU/ 100 ml
  5. WBC count > 18000 cells/mm3

Within 48 hours:

  1. Serum calcium < 8 mg/dL Hematocrit decreased by > 10%
  2. Base deficit > 4 mEq/L
  3. BUN increased by > 2 mg/dL
  4. Sequestered fluid > 6L

Interpretation

  • If the score ≥ 3, severe pancreatitis likely.
  • If the score < 3, severe pancreatitis is unlikely

Or

  • Score 0 to 2 : 2% mortality
  • Score 3 to 4 : 15% mortality
  • Score 5 to 6 : 40% mortality
  • Score 7 to 8 : 100% mortality

Pancreatitis severity can be assessed by any of the following:

  1. Ranson criteria
  2. APACHE II score ≥ 8
  3. Balthazar computed tomography severity index (CTSI)
  4. BISAP score
  5. Organ failure
  6. Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CT)

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