tooluniverse-clinical-risk-scoring

name tooluniverse-clinical-risk-scoring description Compute and interpret validated bedside clinical risk scores and pretest probabilities for an INDIVIDUAL patient — pick the right score for the scenario, gather inputs, run the deterministic calculator tool, and read the result against an interpretation table. Covers CHA2DS2-VASc (AF stroke risk), HAS-BLED (bleeding on anticoagulation), CURB-65 (pneumonia severity / admit decision), qSOFA (sepsis screen), Child-Pugh + MELD-Na (cirrhosis severity / transplant priority), Wells DVT and Wells PE (VTE pretest probability), ASCVD (10-year cardiovascular risk / statin decision), and eGFR CKD-EPI (kidney function / drug dosing). Use when asked things like "stroke risk for this AF patient", "should this patient be anticoagulated", "pneumonia severity — admit or not?", "sepsis screen this patient", "DVT/PE pretest probability", "10-year cardiovascular risk", "cirrhosis severity / MELD score", or "eGFR / kidney function". Pairs CHA2DS2-VASc with HAS-BLED to weigh anticoagulation. NOT for polygenic/genetic risk (use tooluniverse-polygenic-risk-score), NOT for population-level epidemiology/incidence (use tooluniverse-epidemiological-analysis), and NOT for diagnostic test sensitivity/specificity/likelihood-ratio math (use tooluniverse-diagnostic-test-evaluation). disable-model-invocation true Clinical Risk Scoring Turn a clinical scenario into the right validated risk score, compute it with a deterministic calculator tool, and interpret the number into a clinical action. All 10 backing tools are pure-compute (no network, no API key) and return {status, data:{score, interpretation, components, ...}} . This skill is decision-support only — see LIMITATIONS. It does not replace clinical judgment. Step 1 — Map the scenario to the score(s) Clinical scenario Score(s) Tool(s) Atrial fibrillation — stroke risk / anticoagulate? CHA2DS2-VASc and HAS-BLED (pair) ClinicalCalc_CHA2DS2_VASc + ClinicalCalc_HAS_BLED Community-acquired pneumonia — severity / admit? CURB-65 ClinicalCalc_CURB_65 Suspected sepsis (infection + ? deterioration) qSOFA ClinicalCalc_qSOFA Cirrhosis / chronic liver disease severity Child-Pugh and MELD-Na (pair) ClinicalCalc_Child_Pugh + ClinicalCalc_MELD_Na Suspected DVT — pretest probability Wells DVT ClinicalCalc_Wells_DVT Suspected PE — pretest probability Wells PE ClinicalCalc_Wells_PE Primary CVD prevention — 10-yr risk / statin? ASCVD ClinicalCalc_ASCVD_risk Kidney function / renal drug dosing / CKD stage eGFR CKD-EPI ClinicalCalc_eGFR_CKD_EPI When the scenario names a pair , always run both — one alone is misleading (e.g. stroke risk without bleeding risk, or Child-Pugh without MELD-Na). Step 2 — Gather the required inputs Required vs optional inputs per tool (omitted booleans default to false /absent; omitted scalars are rejected when required): Tool Required Key optional booleans/values ClinicalCalc_CHA2DS2_VASc age chf , hypertension , diabetes , stroke_history (2pt), vascular_disease , female ClinicalCalc_HAS_BLED age hypertension , renal_disease , liver_disease , stroke_history , bleeding_history , labile_inr , drugs , alcohol ClinicalCalc_CURB_65 age confusion , elevated_urea (BUN>19), high_resp_rate (>=30), low_bp ClinicalCalc_qSOFA (none) high_resp_rate (>=22), altered_mentation , low_sbp (<=100) ClinicalCalc_Child_Pugh bilirubin , albumin , inr ascites (none/mild/moderate), encephalopathy (none/grade1-2/grade3-4) ClinicalCalc_MELD_Na creatinine , bilirubin , inr , sodium dialysis (forces creatinine to 4.0) ClinicalCalc_Wells_DVT (none) active_cancer , immobilization , recent_surgery , localized_tenderness , leg_swollen , calf_swelling , pitting_edema , collateral_veins , previous_dvt , alternative_diagnosis (-2) ClinicalCalc_Wells_PE (none) clinical_dvt (3), pe_most_likely (3), tachycardia (1.5), immobilization (1.5), previous_vte (1.5), hemoptysis (1), malignancy (1) ClinicalCalc_ASCVD_risk age (40-79), total_cholesterol , hdl_cholesterol , systolic_bp bp_treated , smoker , diabetes , female , race ("white"/"black") ClinicalCalc_eGFR_CKD_EPI creatinine , age female If a required value is missing, ask the user for it — do not guess. State explicitly which booleans you assumed false . Step 3 — Compute tu run ClinicalCalc_CHA2DS2_VASc '{"age":76,"female":true,"hypertension":true,"diabetes":true}' Every tool returns data.score plus a human-readable data.interpretation and a data.components breakdown (per-factor points). MELD/eGFR/ASCVD also return unit ; Child-Pugh returns child_pugh_class ; Wells PE returns three_tier and two_tier . Echo the components so the user can audit which factors drove the score. Step 4 — Interpret (per-score tables) CHA2DS2-VASc (stroke risk in AF, 0–9) Score Stroke risk Action 0 (men) / 1 (women, sex point only) Low No anticoagulation 1 (men) Intermediate Consider anticoagulation >=2 (men) / >=3 (women) Elevated Oral anticoagulation recommended HAS-BLED (major bleeding on anticoagulation, 0–9) Score Bleeding risk Action 0–2 Low–moderate Anticoagulation reasonable >=3 High Caution; correct reversible factors (BP, labile INR, antiplatelet/NSAID, alcohol), closer follow-up — NOT an automatic contraindication How to weigh CHA2DS2-VASc + HAS-BLED together A high HAS-BLED does not by itself withhold anticoagulation . If CHA2DS2-VASc meets the threshold, the stroke benefit usually outweighs bleeding risk; HAS-BLED instead flags modifiable risk factors to fix and patients needing closer monitoring. Only a very high, non-modifiable bleeding risk shifts the decision against anticoagulation. CURB-65 (CAP severity, 0–5) Score 30-day mortality Disposition 0–1 Low (~1.5–3%) Outpatient 2 Intermediate (~9%) Short-stay / inpatient admission 3–5 High (~15–40%) Inpatient; assess for ICU at 4–5 qSOFA (sepsis screen, 0–3) Score Meaning 0–1 Lower risk — does not rule out sepsis; reassess >=2 Higher risk of poor outcome — escalate, full sepsis workup, consider full SOFA / lactate qSOFA is a screen , not a diagnosis; a low score never excludes sepsis. Child-Pugh (cirrhosis severity, class A/B/C) Class Score 1-yr survival (approx) Meaning A 5–6 ~100% Well-compensated B 7–9 ~80% Significant functional compromise C 10–15 ~45% Decompensated; high surgical/anesthetic risk MELD-Na (90-day mortality / transplant priority, 6–40) MELD-Na 90-day mortality (approx) Transplant relevance <=9 ~2% Low priority 10–19 ~6% 20–29 ~20% Rising allocation priority 30–39 ~50% High priority >=40 >50% Highest priority Pair with Child-Pugh: Child-Pugh class anchors chronic severity / surgical risk; MELD-Na drives short-term mortality and transplant listing. Wells DVT (pretest probability) Score Probability Workup <2 (esp. <=0) DVT unlikely D-dimer; if negative, DVT excluded >=2 DVT likely Proceed to compression ultrasound Wells PE (pretest probability) Two-tier Three-tier Workup PE unlikely (<=4) low (0–1) / moderate (2–6) D-dimer; if negative, PE excluded (consider PERC if very low) PE likely (>4) high (>6) CT pulmonary angiography (D-dimer not sufficient to exclude) ASCVD 10-year risk (%) Risk % Category Statin guidance (with shared decision-making) <5% Low Lifestyle 5–7.4% Borderline Consider if risk-enhancers present 7.5–19.9% Intermediate Moderate-intensity statin reasonable >=20% High High-intensity statin eGFR CKD-EPI (mL/min/1.73m^2) → CKD stage eGFR Stage Note >=90 G1 Normal (CKD only if other markers of damage) 60–89 G2 Mildly decreased 45–59 G3a Mild–moderate 30–44 G3b Moderate–severe 15–29 G4 Severe — nephrology referral <15 G5 Kidney failure Use eGFR for renal drug dosing and CKD staging; a single value is an estimate — confirm with a repeat/eGFR trend for staging. Worked example A — Atrial fibrillation, weigh anticoagulation (paired) 76-year-old woman with AF, hypertension, type 2 diabetes; on an NSAID; no prior stroke/bleed, BP controlled, stable INR. tu run ClinicalCalc_CHA2DS2_VASc '{"age":76,"female":true,"hypertension":true,"diabetes":true}' # -> score 5: "Elevated risk (5) — oral anticoagulation recommended" # components: Age>=75 2, Hypertension 1, Diabetes 1, Female 1 tu run ClinicalCalc_HAS_BLED '{"age":76,"hypertension":true,"drugs":true}' # -> score 3: "High bleeding risk (3) — caution, review reversible factors" # components: Hypertension_uncontrolled 1, Elderly_>65 1, Drugs_antiplatelet_NSAID 1 Interpretation. CHA2DS2-VASc 5 (>=3 for a woman) → anticoagulation recommended. HAS-BLED 3 is high but driven by modifiable factors: stop the NSAID and control BP and 2 of the 3 points disappear, lowering bleeding risk. The high HAS-BLED does not cancel anticoagulation — it directs you to fix reversible risks and monitor more closely. Worked example B — Cirrhosis severity and transplant priority (paired) Cirrhotic patient: bilirubin 3.5 mg/dL, albumin 2.5 g/dL, INR 2.4, moderate ascites, grade 1–2 encephalopathy; creatinine 2.0, sodium 128, not on dialysis. tu run ClinicalCalc_Child_Pugh '{"bilirubin":3.5,"albumin":2.5,"inr":2.4,"ascites":"moderate","encephalopathy":"grade1-2"}' # -> score 14, child_pugh_class "C": "Class C (score 14): decompensated disease" tu run ClinicalCalc_MELD_Na '{"creatinine":2.0,"bilirubin":5.0,"inr":2.0,"sodium":128,"dialysis":false}' # -> score 31: "MELD-Na 31: very high ... 90-day mortality risk" Interpretation. Child-Pugh class C (14) = decompensated cirrhosis, very high surgical/anesthetic risk — avoid elective surgery. MELD-Na 31 implies roughly a third-or-higher 90-day mortality and a high transplant-allocation priority. Together they justify urgent hepatology / transplant evaluation. (Note MELD uses bilirubin 5.0 and INR 2.0 from this patient's labs; lower bounds of 1.0 are applied internally.) Completeness checklist Picked the score(s) that match the scenario — ran both members of a pair (CHA2DS2-VASc+HAS-BLED, Child-Pugh+MELD-Na) Confirmed all required inputs; asked for missing ones rather than guessing Stated which optional booleans were assumed false Reported score , interpretation , and the components breakdown Mapped the score to a clinical action using the interpretation table For pairs, explained how to weigh the two scores together Stated the LIMITATIONS caveat (decision-support, validated population, ASCVD age 40–79) LIMITATIONS Decision-support only. These scores inform, but do not replace, clinical judgment and the full clinical picture. Do not present output as a treatment directive. Validated populations. Each score was derived/validated in specific cohorts and may not transfer to children, pregnancy, valvular AF (CHA2DS2-VASc is for non-valvular AF), or other excluded groups. ASCVD Pooled Cohort Equations are validated only for ages 40–79 and the White / African-American coefficient sets; they can mis-estimate for other ancestries and are for primary prevention (no prior ASCVD event). eGFR CKD-EPI assumes stable kidney function (steady-state creatinine); it is unreliable in acute kidney injury, extremes of muscle mass, or amputees, and a single value does not stage CKD on its own. qSOFA / CURB-65 / Wells are screening / pretest-probability tools — a reassuring score does not exclude the diagnosis; combine with clinical gestalt and confirmatory testing. MELD-Na / Child-Pugh apply to chronic liver disease; they do not capture acute liver failure or hepatocellular-carcinoma exception points. Inputs are taken at face value — garbage in, garbage out. Verify lab units (mg/dL vs mmol/L, BUN vs urea) before entry. Not a substitute for institutional protocols, guideline updates, or specialist consultation.