Towards automated calculation of evidence-based clinical scores

doi:10.5662/wjm.v7.i1.16

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Basic Study

World J Methodol. Mar 26, 2017; 7(1): 16-24
Published online Mar 26, 2017. doi: 10.5662/wjm.v7.i1.16

Table 1 Description of modified Delphi methodology

Delphi round 1	Systematic collection of online clinical score calculators	Identified 176 externally validated online clinical score calculators
Delphi round 2	Survey development	Branching survey logic mapped score calculators to applicable specialties
	Survey distribution	Academic and community based clinicians

Table 2 Survey respondent characteristics

	Completion rate	n of Scores
Anesthesia	2/5 (40%)	49
Cardiology	1/1 (100%)	37
Critical care	14/23 (61%)	75
Dermatology	0/0	1
Emergency medicine	4/6 (67%)	62
Family medicine	2/5 (40%)	107
Gastroenterology	3/3 (100%)	17
Hematology	1/1 (100%)	5
Infectious disease	2/2 (100%)	2
Internal medicine	14/25 (56%)	109
Nephrology	1/1 (100%)	6
Neurology	0/1 (0%)	23
OBGYN	1/1 (100%)	1
Oncology	1/2 (50%)	5
Orthopedics	0/0	3
Pediatric	7/13 (54%)	25
Pulmonology	4/6 (67%)	17
Surgery	2/3 (67%)	66

Table 3 Summary of importance of automation of specified clinical scores ranked by critical care and internal medicine physicians

Score name	Year of creation	n of variables	Very important	Very important or nice to have
Critical care
APACHE II	1985	15	9/14 (64.3%)	12/14 (85.7%)
SNAP II	2001	9	7/11 (63.6%)	9/11 (81.8%)
NRDS scoring system	1998	5	7/12 (58.3%)	10/12 (83.3%)
Post-anesthetic recovery score	1970	5	7/12 (58.3%)	9/12 (75%)
Rotterdam score	1997	4	7/12 (58.3%)	8/12 (66.7%)
SNAP	1993	27	7/12 (58.3%)	9/12 (75%)
SNAP-PE	1993	30	7/12 (58.3%)	9/12 (75%)
SNAP-PE II	2001	12	7/12 (58.3%)	9/12 (75%)
Wells criteria for DVT	2006	9	7/12 (58.3%)	9/12 (75%)
Wells criteria for PE	1998	7	7/12 (58.3%)	10/12 (83.3%)
PAWS	2008	7	6/11 (54.5%)	8/11 (72.7%)
CRIB	1993	5	6/12 (50%)	8/12 (66.7%)
CRIB II	2003	5	6/12 (50%)	8/12 (66.7%)
MSSS	2002	7	6/12 (50%)	8/12 (66.7%)
PELOD score	1999	13	3/6 (50%)	4/6 (66.7%)
SAPS II	1993	16	5/10 (50%)	7/10 (70%)
TIMI risk index	2006	3	5/11 (45.5%)	8/11 (72.7%)
TRISS	1987	9	4/9 (44.4%)	6/9 (66.7%)
Children's coma score	1984	3	3/7 (42.9%)	4/7 (57.1%)
PRISM score	1988	16	3/7 (42.9%)	5/7 (71.4%)
CURB-65	2003	5	5/12 (41.7%)	8/12 (66.7%)
SCORETEN scale	2000	6	5/12 (41.7%)	9/12 (75%)
MEWS score	2006	6	4/10 (40%)	6/10 (60%)
Rockall score	2008	11	3/8 (37.5%)	5/8 (62.5%)
TRIOS score	2001	4	3/8 (37.5%)	5/8 (62.5%)
Geneva score for PE	2006	9	4/11 (36.4%)	7/11 (63.6%)
Injury Severity Score	1974	6	4/11 (36.4%)	8/11 (72.7%)
Lung Injury score	1988	5	4/11 (36.4%)	8/11 (72.7%)
MPMII - admission	1993	14	4/11 (36.4%)	6/11 (54.5%)
MPMII - 24-48-72	1993	14	4/11 (36.4%)	6/11 (54.5%)
LODS score	1996	12	3/9 (33.3%)	7/9 (77.8%)
MEDS score	2003	10	3/9 (33.3%)	6/9 (66.7%)
MESS score	1990	5	4/12 (33.3%)	7/12 (58.3%)
Parsonnet Score	1989	14	4/12 (33.3%)	7/12 (58.3%)
Pediatric coma scale	1988	3	2/6 (33.3%)	3/6 (50%)
RAPS	1987	5	3/9 (33.3%)	7/9 (77.8%)
Surgical Apgar score	2007	3	4/12 (33.3%)	8/12 (66.7%)
ASCOT score	1990	8	4/13 (30.8%)	6/13 (46.2%)
MELD score	2001	4	4/13 (30.8%)	12/13 (92.3%)
PIM2	2003	8	2/7 (28.6%)	5/7 (71.4%)
SWIFT score	2008	6	2/7 (28.6%)	4/7 (57.1%)
Clinical Pulmonary Infection Score	1991	8	3/11 (27.3%)	9/11 (81.8%)
MPM-24 h	1988	15	3/11 (27.3%)	6/11 (54.5%)
Child-Pugh Score	1973	5	3/12 (25%)	11/12 (91.7%)
Decaf score	2012	5	2/8 (25%)	4/8 (50%)
ONTARIO score	1995	6	2/8 (25%)	4/8 (50%)
AKICS score	2007	8	3/13 (23.1%)	7/13 (53.8%)
AVPU scale	2004	4	2/9 (22.2%)	6/9 (66.7%)
PERC rule for PE	2001	7	2/9 (22.2%)	6/9 (66.7%)
RIETE score	1988	6	2/9 (22.2%)	6/9 (66.7%)
BISAP score for pancreatitis mortality	2008	5	2/10 (20%)	4/10 (40%)
Bleeding risk score	2007	4	2/10 (20%)	6/10 (60%)
Clinical asthma evaluation score	1972	5	2/10 (20%)	6/10 (60%)
PIRO score	2009	8	2/10 (20%)	7/10 (70%)
ABC score for massive transfusion	2009	4	2/11 (18.2%)	6/11 (54.5%)
ACLS score	1981	4	2/11 (18.2%)	7/11 (63.6%)
MOD score	1995	7	2/11 (18.2%)	8/11 (72.7%)
MPM - admission	1988	10	2/11 (18.2%)	6/11 (54.5%)
sPESI	2010	8	2/11 (18.2%)	7/11 (63.6%)
ABIC score	2008	4	2/12 (16.7%)	5/12 (41.7%)
CRUSADE score	2009	8	2/12 (16.7%)	6/12 (50%)
Pediatric trauma score	1988	6	1/6 (16.7%)	2/6 (33.3%)
LRINEC Score for Necrotizing STI	2004	5	1/8 (12.5%)	4/8 (50%)
Panc 3 score	2007	3	1/8 (12.5%)	3/8 (37.5%)
Pancreatitis outcome score	2007	7	1/8 (12.5%)	3/8 (37.5%)
TASH score	2006	7	1/8 (12.5%)	4/8 (50%)
POSSUM score	1991	18	1/9 (11.1%)	3/9 (33.3%)
Revised Trauma score	1981	3	1/9 (11.1%)	5/9 (55.6%)
24 h ICU trauma score	1992	4	1/10 (10%)	7/10 (70%)
HIT Expert Probability Score	2010	11	1/11 (9.1%)	6/11 (54.5%)
Bronchiectasis severity index	2014	10	1/12 (8.3%)	4/12 (33.3%)
Oxygenation index	2005	3	1/13 (7.7%)	7/13 (53.8%)
CT severity index	1990	1	0/12 (0%)	6/12 (50%)
Glasgow coma scale	1974	3	0/13 (0%)	10/13 (76.9%)
SOFA	2001	6	0/13 (0%)	8/13 (61.5%)
Internal medicine
Wells criteria for DVT	2006	9	10/14 (71.4%)	13/14 (92.9%)
Wells criteria for PE	1998	7	10/14 (71.4%)	13/14 (92.9%)
CHA2DS2-VASc	2010	7	9/14 (64.3%)	13/14 (92.9%)
TIMI risk index	2006	3	9/14 (64.3%)	13/14 (92.9%)
TIMI risk score for UA/NSTEMI	2000	7	9/14 (64.3%)	13/14 (92.9%)
TIMI risk score for STEMI	2000	9	9/14 (64.3%)	13/14 (92.9%)
CURB-65	2003	5	8/14 (57.1%)	13/14 (92.9%)
STESS score	2008	4	8/14 (57.1%)	13/14 (92.9%)
Duke criteria for IE	1994	8	6/13 (46.2%)	12/13 (92.3%)
PESI	2006	11	7/12 (58.3%)	11/12 (91.7%)
Revised cardiac risk index for pre-operative risk	1999	6	7/12 (58.3%)	11/12 (91.7%)
SOFA	2001	6	6/12 (50%)	11/12 (91.7%)
ABCD2 score	2006	5	5/12 (41.7%)	11/12 (91.7%)
Charlson Comorbidity index	1987	1	2/12 (16.7%)	11/12 (91.7%)
PERC rule for PE	2001	7	5/11 (45.5%)	10/11 (90.9%)
sPESI	2010	8	4/11 (36.4%)	10/11 (90.9%)
MOD score	1995	7	3/11 (27.3%)	10/11 (90.9%)
MPM - 24 h	1988	15	4/10 (40%)	9/10 (90%)
MPM - admission	1988	10	3/10 (30%)	9/10 (90%)
MEDS score	2003	10	2/10 (20%)	9/10 (90%)
PIRO score	2009	8	1/10 (10%)	9/10 (90%)
SAPS II	1993	16	4/9 (44.4%)	8/9 (88.9%)
SWIFT score	2008	6	2/8 (25%)	7/8 (87.5%)
Panc 3 score	2007	3	1/8 (12.5%)	7/8 (87.5%)
APACHE II	1985	15	9/14 (64.3%)	12/14 (85.7%)
Parsonnett Score	1989	14	8/14 (57.1%)	12/14 (85.7%)
HIT Expert Probability Score	2010	11	6/14 (42.9%)	12/14 (85.7%)
Ranson's criteria	1974	11	6/14 (42.9%)	12/14 (85.7%)
TRIOS score	2001	4	3/7 (42.9%)	6/7 (85.7%)
4Ts Score	2006	5	5/14 (35.7%)	12/14 (85.7%)
Framingham coronary heart disease risk score	1998	7	5/14 (35.7%)	12/14 (85.7%)
30 d PCI readmission risk	2013	10	2/7 (28.6%)	6/7 (85.7%)
Glasgow coma scale	1974	3	9/13 (69.2%)	11/13 (84.6%)
Modified NIH Stroke Scale	2001	9	7/13 (53.9%)	11/13 (84.6%)
King's College Criteria for Acetaminophen Toxicity	1989	6	4/12 (33.3%)	10/12 (83.3%)
Glasgow-Blatchford Bleeding score	2000	9	3/12 (25%)	10/12 (83.3%)
ATRIA bleeding risk score	2011	6	2/12 (16.7%)	10/12 (83.3%)
Glasgow Alcoholic hepatitis score	2005	4	5/11 (45.5%)	9/11 (81.8%)
MEWS score	2006	6	4/11 (36.4%)	9/11 (81.8%)
Hemorr2hages score	2006	11	2/11 (18.2%)	9/11 (81.8%)
Decaf score	2012	5	4/10 (40%)	8/10 (80%)
MPMII - admission	1993	14	4/10 (40%)	8/10 (80%)
MPMII - 24-48-72	1993	14	4/10 (40%)	8/10 (80%)
Malnutrition universal screening tool (MUST)	2004	3	2/10 (20%)	8/10 (80%)
ASTRAL score	2012	6	1/10 (10%)	8/10 (80%)
GRACE ACS	2006	12	1/10 (10%)	8/10 (80%)
CHADS2	2001	5	7/14 (50%)	11/14 (78.6%)
Multidimensional frailty score	2014	9	7/14 (50%)	11/14 (78.6%)
Geneva score for PE	2006	9	3/9 (33.3%)	7/9 (77.8%)
Pittsburg knee rules	1994	3	3/9 (33.3%)	7/9 (77.8%)
Mayo scoring system for assessment of ulcerative colitis activity	2005	4	1/9 (11.1%)	7/9 (77.8%)
4-yr mortality prognostic index	2006	12	1/9 (11.1%)	7/9 (77.8%)
Rockall score	2008	11	1/9 (11.1%)	7/9 (77.8%)
SHARF scoring system	2004	9	1/9 (11.1%)	7/9 (77.8%)
HAS-BLED	2010	12	5/13 (38.5%)	10/13 (76.9%)
ATRIA stroke risk score	2013	7	3/12 (25%)	9/12 (75%)
Euroscore	1999	17	1/8 (12.5%)	6/8 (75%)
Renal risk score	2011	6	1/8 (12.5%)	6/8 (75%)
ROSE risk score	1996	7	1/8 (12.5%)	6/8 (75%)
LRINEC Score for Necrotizing STI	2004	5	3/11 (27.3%)	8/11 (72.7%)
Bleeding risk score	2007	4	2/11 (18.2%)	8/11 (72.7%)
CT severity index	1990	1	1/11 (9.1%)	8/11 (72.7%)
SCORETEN scale	2000	6	7/14 (50%)	10/14 (71.4%)
REMS	2004	7	2/7 (28.6%)	5/7 (71.4%)
Mayo CABG risk of inpatient death after MI	2007	7	1/7 (14.3%)	5/7 (71.4%)
Mayo PCI risk of inpatient MACE	2007	7	1/7 (14.3%)	5/7 (71.4%)
QMMI score	2001	11	1/7 (14.3%)	5/7 (71.4%)
MELD score	2001	4	0/14 (0%)	10/14 (71.4%)
Nexus criteria for C-spine imaging	1970	5	4/10 (40%)	7/10 (70%)
Birmingham nutritional risk score	1995	7	2/10 (20%)	7/10 (70%)
Canadian CT head rule	2001	9	2/10 (20%)	7/10 (70%)
ACLS score	1981	4	1/10 (10%)	7/10 (70%)
San Francisco syncope rule	2004	5	1/10 (10%)	7/10 (70%)
Mannheim peritonitis index	1993	7	6/13 (46.2%)	9/13 (69.2%)
HADO score	2006	4	3/9 (33.3%)	6/9 (66.7%)
CARE score	2001	3	1/9 (11.1%)	6/9 (66.7%)
ICH score	2001	5	1/9 (11.1%)	6/9 (66.7%)
Adult appendicitis score	2014	8	6/14 (42.9%)	9/14 (64.3%)
IMPACT score	2008	11	6/14 (42.9%)	9/14 (64.3%)
CRUSADE score	2009	8	4/14 (28.6%)	9/14 (64.3%)
PORT/PSI score	1997	20	2/14 (14.3%)	9/14 (64.3%)
CIWA-Ar	1989	10	1/14 (7.1%)	9/14 (64.3%)
LODS score	1996	12	3/8 (37.5%)	5/8 (62.5%)
OESIL risk score	2003	4	2/8 (25%)	5/8 (62.5%)
QRISK2	2010	14	2/8 (25%)	5/8 (62.5%)
Qstroke score	2013	15	2/8 (25%)	5/8 (62.5%)
RIETE score	1988	6	2/8 (25%)	5/8 (62.5%)
EGSYS score	2008	6	1/8 (12.5%)	5/8 (62.5%)
EHMRG	2012	10	1/8 (12.5%)	5/8 (62.5%)
FOUR score	2005	4	1/8 (12.5%)	5/8 (62.5%)
Pancreatitis outcome score	2007	7	1/8 (12.5%)	5/8 (62.5%)
Prostate cancer prevention trial risk calculator	1993	6	6/13 (46.2%)	8/13 (61.5%)
Alvarado score for acute appendicitis	1986	8	5/13 (38.5%)	8/13 (61.5%)
DRAGON score	2012	6	1/10 (10%)	6/10 (60%)
Bronchiectasis severity index	2014	10	3/14 (21.4%)	8/14 (57.1%)
New Orleans head CT rule	2000	8	1/7 (14.3%)	4/7 (57.1%)
POSSUM score	1991	18	1/7 (14.3%)	4/7 (57.1%)
Child-Pugh Score	1973	5	0/14 (0%)	8/14 (57.1%)
Lung Injury score	1988	5	4/9 (44.4%)	5/9 (55.6%)
AVPU scale	2004	4	2/9 (22.2%)	5/9 (55.6%)
Gupta perioperative cardiac risk	2011	5	2/9 (22.2%)	5/9 (55.6%)
HEART score	2008	5	1/9 (11.1%)	5/9 (55.6%)
IgA nephropathy score	2006	8	5/14 (35.7%)	7/14 (50%)
ABIC score	2008	4	4/14 (28.6%)	7/14 (50%)
CAMBS score	1993	4	4/14 (28.6%)	7/14 (50%)
GAP risk assessment score	2012	4	2/8 (25%)	4/8 (50%)
BISAP score for pancreatitis mortality	2008	5	2/10 (20%)	5/10 (50%)
ONTARIO score	1995	6	1/8 (12.5%)	4/8 (50%)
JAMA kidney failure risk equation	2011	7	4/13 (30.8%)	5/13 (38.5%)

Table 4 Predictors of desirability of score automation based on number of each variable type in each score

Automation: Very important/nice to have	OR (95%CI)
Critical care
n of variables	0.68 (0.23, 1.59)
Clinical history	1.36 (0.36, 4.93)
Vital sign	1.40 (0.53, 4.6)
Medication	4.89 (0.10, 237.52)
Clinical judgment	2.33 (0.76, 9.80)
Examination	0.99 (0.36, 3.14)
Laboratory value	1.48 (0.61, 4.41)
Charted variable (non-vital)	2.26 (0.70, 8.93)
Demographic value	0.20 (0.03, 1.00)
Another score	2.07 (0.39, 12.13)
Internal medicine
n of variables	0.64 (0.39, 1.04)
Clinical history	2.34^a (1.26, 4.67)
Vital sign	1.88^a (1.03, 3.68)
Medication	2.89 (0.37, 63.17)
Clinical judgment	1.41 (0.75, 2.74)
Examination	1.56 (0.88, 2.87)
Laboratory value	1.51 (0.90, 2.62)
Charted variable (non-vital)	2.54 (0.85, 8.70)
Demographic value	0.90 (0.41, 1.97)
Another score	0.89 (0.30, 2.17)

^aP < 0.05.

Citation: Aakre CA, Dziadzko MA, Herasevich V. Towards automated calculation of evidence-based clinical scores. World J Methodol 2017; 7(1): 16-24
URL: https://www.wjgnet.com/2222-0682/full/v7/i1/16.htm
DOI: https://dx.doi.org/10.5662/wjm.v7.i1.16