Feb 17 2012

Top 10 Clinical Criteria/Scoring Systems for Internists and Medical Students

Clinical scoring systems, clinical criteria, and clinical prediction rules are used widely in medicine and academics. They are used to aid physicians in their clinical decision making and finalizing a diagnosis. Although they should never be used in place of a physician’s sound clinical judgment, they are great clinical tools and methodologies used to organize data.

Below I have listed my “Top 10 Clinical Criteria/Scoring Systems for Internists and Medical Students.” As a medical student whether you want to be an internal medicine doctor or not, you will be using these on your medicine and hospital rotations. These are also important for Interns and Internal Medicine physicians to know.

1. Systemic Inflammatory Response Syndrome (SIRS) Criteria. The first set of criteria along the sequence leading to septic shock in critically ill patients. The sequence is SIRS → Sepsis → Severe Sepsis → Septic Shock.

2. Acute Respiratory Distress Syndrome (ARDS) Criteria. Used to diagnose ARDS which affects the lungs in critically ill patients.

3. Wells’ Criteria. Two separate sets of criteria. One is for determining the risk of pulmonary embolism (PE) and the other is for determining the risk of deep vein thrombosis (DVT).

4. Ranson’s Criteria. Used for determining the prognosis and severity in patients with pancreatitis.

5. CHADS2 Score. Used for determining the risk of stroke in patients with atrial fibrillation.

6. TIMI Score. Two separate sets of criteria. One is for risk of death in patients with unstable angina or Non-ST Segment Elevation Myocardial Infarction (NSTEMI). The other is for risk of death in patients with ST segment elevation myocardial infarction (STEMI).

7. Light’s Criteria. Used to distinguish transudative from exudative pleural effusions.

8. APACHE II Score. Used to determine the risk of death in ICU patients.

9. Child-Pugh (Child-Turcotte-Pugh) Score and Model for End-Stage Liver Disease (MELD) Score. Two separate sets of criteria. Both are used to determine the prognosis and the need for transplantation in patients with chronic liver disease.

10. CURB-65 Score and Pneumonia Severity Index (PSI)/PORT Score. Two separate sets of criteria. Both are used to determine the risk of death in patients with community-acquired pneumonia (CAP).

Other important clinical scoring systems/criteria to know (but did not make the top 10):

  • Modified (Revised) Jones Criteria for diagnosing rheumatic fever.
  • Modified (Revised) Duke Criteria for diagnosing infective endocarditis.
  • Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) Score for determining the need for treatment in alcohol withdrawal patients
  • Rockall Score for determining risk of death and re-bleed in patients with an upper gastrointestinal (GI) bleed.
  • Modified Centor Score for determining the probability of Strep throat (caused by Group A β-hemolytic Streptococcus pyogenes) in patients with pharyngitis (sore throat).
  • National Emergency X-Radiography Utilization Study (NEXUS) Criteria for determining the need for imaging of the cervical spine (C-spine) in patients with injuries.

The list above is by no means exhaustive or complete, but consists of the most common and clinically relevant criteria/scoring systems that I have encountered in my clinical experience. If I have made an error by omission, or you feel that one should not be included, please comment below.

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