Popoveniuc developed a score for identifying a patient with myxedema coma. Prompt diagnosis and therapy can reduce the risk of death. The authors are from MedStar Washington Hospital Center, Georgetown University, Veterans Affairs Medical Center Washington, and Howard University.
Patient selection: hypothyroidism
Parameters:
(1) thermoregulatory dysfunction temperature in °C
(2) central nervous system effects
(3) gastrointestinal findings
(4) precipitating event
(5) bradycardia
(6) other ECG changes (QT prolongation, low voltage complexes, bundle branch block, nonspecific ST-T changes, other heart blocks)
(7) pericardial and/or pleural effusions
(8) pulmonary edema
(9) cardiomegaly
(10) hypotension
(11) hyponatremia
(12) hypoglycemia
(13) hypoxemia
(14) hypercarbia
(15) decreased GFR
Cardiovascular dysfunction category: items 5 to 10
Metabolic disturbance: items 11 to 15
|
Parameters |
Findings |
Points |
|
thermoregulatory dysfunction temperature |
> 35°C |
0 |
|
|
32 - 35°C |
10 |
|
|
< 32°C |
20 |
|
CNS effects |
absent |
0 |
|
|
somnolent/lethargic |
10 |
|
|
obtunded |
15 |
|
|
stupor |
20 |
|
|
coma/seizures |
20 |
|
GI findings |
none |
0 |
|
|
anorexia, abdominal pain, constipation |
5 |
|
|
decreased intestinal motility |
15 |
|
|
paralytic ileus |
20 |
|
precipitating event |
absent |
0 |
|
|
present |
10 |
|
heart rate (bradycardia) |
>= 60 beats per minute |
0 |
|
|
50 to 59 beats per minute |
10 |
|
|
40 to 49 beats per minute |
20 |
|
|
< 40 beats per minute |
30 |
|
other ECG changes |
absent |
0 |
|
|
present |
10 |
|
pericardial/pleural effusion |
absent |
0 |
|
|
present |
10 |
|
pulmonary edema |
absent |
0 |
|
|
present |
10 |
|
cardiomegaly |
absent |
0 |
|
|
present |
15 |
|
hypotension |
absent |
0 |
|
|
present |
20 |
|
hyponatremia |
absent |
0 |
|
|
present |
10 |
|
hypoglycemia |
absent |
0 |
|
|
present |
20 |
|
hypoxemia |
absent |
0 |
|
|
present |
10 |
|
hypercarbia |
absent |
0 |
|
|
present |
10 |
|
decrease in GFR |
absent |
0 |
|
|
present |
10 |
score =
= (points for thermoregulatory dysfunction temperature) + (points for CNS effects) + (points for GI findings) + (points for precipietating event) + MAX(heart rate, ECG, effusion, pulmonary edema, cardiomegaly, hypotension) + (MAX(hyponatremia, hypoglycemia, hypoxemia, hypercarbia, decrease GFR)
Interpretation:
• minimum score: 0
• maximum score: 120
• A score >= 60 is highly suggestive of myxedema coma.
• A score < 25 makes myxedema coma unlikely.
Performance:
• The area under the ROC curve was 0.88.
Specialty: Endocrinology, Neurology
