Patient selection: adult (>= 18 years of age) with myxedema coma
Parameters:
(1) Glasgow Coma Score (GCS)
(2) serum TSH concentration in mU/L
(3) serum free T4 concentration in ng/dL
(4) body temperature
(5) heart rate
(6) precipitating event (burns, carbon monoxide poisoning, GI hemorrhage, infection, sepsis, drugs, stroke, surgery, other)
|
Parameter
|
Finding
|
Points
|
|
Glasgow coma score
|
15
|
0
|
|
|
14
|
2
|
|
|
11 to 13
|
3
|
|
|
3 to 10
|
4
|
|
serum TSH
|
< 15 mU/L
|
0
|
|
|
15 to 30 mU/L
|
1
|
|
|
> 30 mU/L
|
2
|
|
serum free T4
|
>= 0.6 ng/dL
|
0
|
|
|
< 0.6 ng/dL (low)
|
1
|
|
body temperature
|
>= 95°F
|
0
|
|
|
< 95°F (hypothermia)
|
1
|
|
heart rate
|
>= 60 beats per minute
|
0
|
|
|
< 60 beats per minute (bradycardia)
|
1
|
|
precipitating event
|
absent
|
0
|
|
|
present
|
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score >= 5 was associated with myxedema coma.
Performance:
• The area under the ROC curve was 0.87.
• The sensitivity at the cutoff was 80% with a specificity of 80%.
