Burch-Wartofsky point scale (thyroid storm)
Likelihood of thyroid storm in thyrotoxicosis.
Inputs
CompleteTemperature
CNS effects
GI or hepatic dysfunction
Heart rate
Heart failure
Atrial fibrillation
Precipitating event identified
Worked calculation
Your values are highlighted.
- Points
When to use
- Thyrotoxic patients who appear ill.
Pearls and pitfalls
- 45 or higher: highly suggestive of storm; treat aggressively (beta-blocker, thionamide, iodine after thionamide, steroids).
Why use
Standard storm assessment.
| Criterion | Points |
|---|---|
| Temperature: Below 37.2 °C (99 °F) | 0 |
| 37.2–37.7 °C (99–99.9 °F) | +5 |
| 37.8–38.2 °C (100–100.9 °F) | +10 |
| 38.3–38.8 °C (101–101.9 °F) | +15 |
| 38.9–39.3 °C (102–102.9 °F) | +20 |
| 39.4–39.9 °C (103–103.9 °F) | +25 |
| 40 °C (104 °F) or higher | +30 |
| CNS effects: Absent | 0 |
| Mild agitation | +10 |
| Delirium, psychosis, or extreme lethargy | +20 |
| Seizure or coma | +30 |
| GI or hepatic dysfunction: Absent | 0 |
| Diarrhea, nausea, vomiting, or abdominal pain | +10 |
| Unexplained jaundice | +20 |
| Heart rate: Below 90 | 0 |
| 90–109 | +5 |
| 110–119 | +10 |
| 120–129 | +15 |
| 130–139 | +20 |
| 140 or higher | +25 |
| Heart failure: Absent | 0 |
| Mild (pedal edema) | +5 |
| Moderate (bibasilar rales) | +10 |
| Severe (pulmonary edema) | +15 |
| Atrial fibrillation | +10 |
| Precipitating event identified | +10 |