Burch-Wartofsky_Point_Scale_BWPS_for_thyrotoxicosis v.1

Burch-Wartofsky Point Scale (BWPS) is a tool to predict the likelihood of a thyroid storm in biochemical thyrotoxicosis patients. The scale is based on the following criteria: 1. Temperature: <99 °F (<37.2 °C): 0 points 99–99.9 °F (37.2-37.7 °C): 5 points 100–100.9 °F (37.8-38.2 °C): 10 points 101–101.9 °F (38.3-38.8 °C): 15 points 102–102.9 °F (38.9-39.2 °C): 20 points 103–103.9 °F (39.3-39.9 °C): 25 points ≥104.0 °F (≥ 40.0 °C): 30 points 2. Central nervous system effects Absent: 0 points Mild (agitation): 10 points Moderate (delirium, psychosis, extreme lethargy): 20 points Severe (seizures, coma): 30 points 3. Gastrointestinal-hepatic dysfunction Absent: 0 points Moderate (diarrhea, nausea/vomiting, abdominal pain): 10 points Severe (unexplained jaundice): 20 points 4. Heart rate (beats/minute) <90: 0 points 90-109: 5 points 110-119: 10 points 120-129: 15 points 130-139: 20 points ≥140: 25 points 5. Congestive heart failure Absent: 0 points Mild (pedal edema): 5 points Moderate (bibasilar rales): 10 points Severe (pulmonary edema): 15 points 6. Atrial fibrillation Absent: 0 points Present: 10 points 7. Precipitating event Absent: 0 points Present: 10 points The scale is calculated from the addition of points from the assessment criteria. BWPS <25 is unlikely to represent thyroid storm; investigate diagnosis of thyrotoxicosis (Graves disease, toxic adenoma, toxic multinodular goiter, subacute thyroiditis, exogenous levothyroxine, struma ovarii) and obtain additional imaging (thyroid ultrasound, radioactive iodine uptake and scan). BWPS 25-44 suggests impending thyroid storm; consider thionamides, symptom management. Consider ICU monitoring. BWPS ≥45 is highly suggestive of thyroid storm; consider rapid and aggressive multimodal management in ICU.

Winner Ng

dokter.winner@gmail.com

@CambioCDS

To predict the likelihood of thyroid storm in thyrotoxicosis patients.

In patients ≥18 years old with biochemical thyrotoxicosis.

1. Burch HB, Wartofsky L. Life-Threatening Thyrotoxicosis. Thyrotoxic storm. Endocrinology and Metabolism Clinics of North America . 1993; 22(2): 263-77. 2. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86, vii.

OBSERVATION.body_temperature.v2, OBSERVATION.pulse.v2, OBSERVATION.burch_wartofsky_point_scale_bwps_for_thyrotoxicosis.v0, EVALUATION.burch_wartofsky_point_scale_bwps_for_thyrotoxicosis.v0