Burch-Wartofsky score
With the Burch-Wartofsky score , the probability of the presence of a thyrotoxic crisis can be quantified purely on the basis of clinical and physical criteria, regardless of the level of thyroid hormones .
This point scale includes body temperature, central nervous effects, hepatogastrointestinal symptoms, cardiovascular dysfunction and the patient's medical history.
| parameter | value | Points |
|---|---|---|
| temperature | <37.7 ° C / <99.9 ° F | 5 points |
| 37.8-38.3 ° C / 100-100.9 ° F | 10 points | |
| 38.4-38.8 ° C / 101-101.9 ° F | 15 points | |
| 38.9-39.4 ° C / 102-102.9 ° F | 20 points | |
| 39.5-39.9 ° C / 103-103.9 ° F | 25 points | |
| ≥ 40 ° C / ≥ 104 ° F | 30 points | |
| Central nervous symptoms | Missing | 0 points |
| Mild ( agitation ) | 10 points | |
| Moderate ( delirium , psychosis , extreme lethargy ) | 20 points | |
| Severe ( seizures , coma ) | 30 points | |
| Hepato - gastrointestinal dysfunction | Missing | 0 points |
| Moderate (diarrhea, nausea, vomiting, abdominal pain) | 10 points | |
| Severe (unexplained jaundice ) | 20 points | |
|
Cardiovascular dysfunction 1 ( tachycardia ) |
90-109 / minute | 5 points |
| 110-119 / minute | 10 points | |
| 120-129 / minute | 15 points | |
| 130-139 / minute | 20 points | |
| ≥ 140 / minute | 25 points | |
|
Cardiovascular dysfunction 2 ( heart failure ) |
Missing | 0 points |
| Mild (leg edema ) | 5 points | |
| Moderate (bibasilar rattling noises ) | 10 points | |
| Severe ( pulmonary edema ) | 15 points | |
|
Cardiovascular dysfunction 3 ( atrial fibrillation ) |
Missing | 0 points |
| Available | 10 points | |
| Suggestive medical history | Missing | 0 points |
| Available | 10 points |
The point values are added up and then result in the score value.
A thyrotoxic crisis is possible with a score of over 25 points, it is probable if more than 45 points are reached.
The value of the Burch-Wartofsky score lies in the fact that the probability of thyrotoxicosis can be estimated even before the level of thyroid hormones in the blood plasma has been determined. This is e.g. B. important in intensive and emergency medicine .
rating
The Burch-Wartofsky score has so far only been evaluated in small studies. The original publication by Burch and Wartofsky is based e.g. B. on the retrospective examination of 60 literature cases.
literature
- Burch, HB and L. Wartofsky (1993): Life-Threatening Thyrotoxicosis. Thyrotoxic storm. Endocrinology and Metabolism Clinics of North America 22 (2): 263-277.