Scores

A Palm OS based program for medical scoring systems

Copyright © 2001-2003  Small Systems Software Development
All Rights Reserved.

Introduction and Disclaimer

One of the drawbacks to the many scoring systems that exist is that unless they are used regularly, they tend to be forgotten.  This program attempts to address this problem by giving the user easy access to various scoring systems on their Palm OS based hand held computer (PDA).

This program is distributed in two versions.  The trial version will “nag” you to register. Whenever you choose a scoring system, the program will pop up a screen to suggest registration that will be visible for approximately 4 seconds. After this the screen clears and the program behaves normally.  The full version eliminates this “nag”.

The trial version is freely distributable.  Feel free to share it with friends and colleagues.  However, the full version is not. The full version is licensed to a single user, and redistribution is a violation of applicable copyright laws. The fines are serious – small businesses such as medical practices and health care institutions can be fined up to $150,000 per copy.

You may obtain the full version from either our website, www.smallsyssoft.com, Handango.com, or PalmGear.com.  

This program should not substitute for clinical judgement.  The applicability of a scoring system to a particular clinical situation or patient is not implied, and we can take no responsibility for any adverse outcome that may occur through the use of such scoring systems.  This software is supplied without warranty.  

Installation

Double click the Scores.prc file (or scoressw.prc if using the shareware version) to launch the Hot Sync manager.  If you have more than one PDA set up for this computer you will be presented with a list and can choose which PDA you wish the program installed on.  Click Done, then perform a Hot Sync.  The program will then be installed on your PDA.

Running Scores

Tap the Medical Scores icon on your PDA to launch the program.  You will be presented with a screen full of buttons, each of which is connected to a scoring system.  You can also choose a scoring system from the menu.  There are 3 main ways that a scoring system is presented by the program.  First, there are simple scoring systems where the system is simply shown to the user (Jones Criteria for example).  Second, there are sets of checkboxes and entry blanks for the user to complete (Fine Pneumonia score, Duke endocarditis criteria, etc.).  Finally, there are systems where each question is presented with a set of potential responses.  The user chooses a response, and the program moves to the next question.  Hamilton Depression Scale and NIH Stroke scale are handled in this manner.

Also, there is a pulmonary embolus probability calculator.  Based on values from the literature on sensitivity and specificity of various tests, you can enter a prior probability, and the program will use Bayes’ Theorem to calculate post test probabilities.  You can then choose to make the post test probability for one test the prior probability for the next calculation.  Please note that chaining test results like this may not be mathematically valid, and is clearly not valid if the tests are related (2 different D Dimer assays, for example, or CT and MRI).

Specific Scoring Systems

Glasgow Coma Scale [1] – choose the best values for eyes, verbal, and motor function.  The program then gives you a calculated total.  Please note that the best documentation would include the subscores for each item – for example, E4V5M6 = 15.   

Child’s Class[2] – choose the bilirubin level, albumen, degree of ascites, encephalopathy, and protime compared to control to obtain the Child Pugh score and classification.

Jones Criteria[3] – check the appropriate boxes under Major and Minor criteria.  Diagnostic criteria are then listed at the bottom of the screen.

Duke Endocarditis score[4][10] – the first screen is a set of checkboxes of major criteria.  The next screen is the minor criteria.  The final screen gives a tally.

Fine Pneumonia score[5] – the first screen is a set of checkboxes and one text entry for the age. Click the Calc button to get a score, class, and predicted mortality.

NIH Stroke Scale [6] – you are presented with the set of questions for the NIH stroke scale. Click each appropriate response, and the program moves to the next question.  You may move back by clicking the Prev button.  Finally you are presented the score.  Of note, this scale is modified removing reference to prior results.  See the reference.

TPA Version – this is the version of the NIH stroke scale that is used in the TPA studies in stroke.  Available from various sources, operation is the same as the NIH stroke scale above.

Hamilton Depression Scale [7] – you are presented with a set of questions.  Click the appropriate response, and the program moves to the next question.  Finally, you are presented with a score and the ranges typically used to interpret the score.

Mini Mental Status [8] – check the boxes the patient got correct, pick from the lists how many items the patient got correct, then click next.  Complete those questions similarly, then click Calculate.  The score is displayed. 

Pre-op Cardiac Risk assessment [9] – tap the appropriate checkboxes then tap Calc to obtain a score, class, and anticipated risk.

Pulmonary Embolus calculator [11][12] – enter the pretest probability of a pulmonary embolus, choose the test from the list, and tap the button to calculate the post test probability.  Please see notations above regarding chaining tests together. 

References:

1.	Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-84 and as widely reproduced.
2.	Goroll: Primary Care Medicine, 4th Ed. (2000): Chapter 71, page 464.
3.	Harrison’s Textbook of Internal Medicine 12th Edition Chapter 187, page 935.
4.	Duke Infective Endocarditis Criteria, from http://www.med.upenn.edu/bugdrug/antibiotic_manual/duke.htm (University of Pennsylvania Health System web site)
5.	Fine, Michael J.; Auble, Thomas E.; et.al. A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia. N Engl J Med 1997;336(4):243-250.
6.	Brott T, Adams H, et.al.: Measurements of Acute Cerebral Infarction: A Clinical Examination Scale. Stroke 1989;20(7):864-970.
7.	Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56-62. Reproduced in Merck Manual for Geriatrics, online edition.
8.	Adapted from Folstein, et.al. Mini Mental State: A practical method for grading the cognitive state of patients for the clinician, J Psych Res 1975;12:189,.
9.	American College of Physicians: Guidelines for Assessing and Managing the Perioperative Risk from Coronary Artery Disease Associated with Major Noncardiac Surgery. Ann Int Med 1997;127(15 Aug):309-312.
10.	Goldman: Cecil Textbook of Medicine, 21st Ed.(2000) Chapter 326, page 1635.
11.	Kline J, Johns K, Coluccielllo S, Israel E. New diagnostic test for pulmonary embolism. Ann Emerg Med 2000; 35(2):168-179.
12.	Mullins M, Becker D, Hagspiel K, Philbrick J. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Int Med 2000;160(3):293-298.