van der Wilden et al reported a risk scoring system (RSS) for predicting the risk of fulminant Clostridium difficile disease. This can help to identify a patient who may require more aggressive management or surgery. The authors are from Massachusetts General Hospital, Harvard Medical School and Leiden University.
Patient selection: Clostridium difficile colitis
Parameters:
(1) age in years
(2) WBC count per microliter
(3) cardiorespiratory failure (need for mechanical ventilation and/or vasopressors)
(4) diffuse abdominal tenderness
Parameter
Finding
Points
age in years
<= 70 years
0
> 70 years
2
WBC count
< 2,000 per µL
1
2,000 to 19,999
0
>= 20,000 per µL
1
cardiorespiratory failure
no
0
yes
7
diffuse abdominal tenderness
no
0
yes
6
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the greater the risk for fulminant Clostridium difficile disease.
Total Score
Fulminant CdD
0 to 3
< 1%
4 or 5
score not generated
6
8%
7
15%
8
25%
9
38%
10 to 12
score not generated
13 to 16
100%
Performance:
• The authors reported an area of the ROC curve of 0.98.
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