When presenting a patient, which disease "scores" do you include?

[PddppfCl2]

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CHADS2, Wells' Score, MELD, PSI/PORT, etc...

Is there a basic set that you always include? For example, for all suspected PE's include Wells' Score in the presentation, for all Afib's include CHADS2 score, etc..

 

[link2swim06]

CHADS2, Wells' Score, MELD, PSI/PORT, etc...

Is there a basic set that you always include? For example, for all suspected PE's include Wells' Score in the presentation, for all Afib's include CHADS2 score, etc..

I don't present it in the history or physical. However, sometimes I would say that I want to do a d-dimer because the patient has a low pre-test probability (calculated by a well's score).

Only include them to support your workup/treatment plan.

 

[SouthernSurgeon]

CHADS2, Wells' Score, MELD, PSI/PORT, etc...

Is there a basic set that you always include? For example, for all suspected PE's include Wells' Score in the presentation, for all Afib's include CHADS2 score, etc..

It really depends.

For cirrhotics, yeah I would throw their MELD in as part of the one liner - "this is a 54 year old man with a history of etoh cirrhosis, MELD 24"

Because that's a very quick way of telling someone how sick that patient is.

But of the others you discuss, I would only possibly use them in my assessment/plan portion of the case - ex:

"Given this patient's CHADS2 score, long-term anticoagulation for his atrial fibrillation is indicated"

 

[Charles_Carmichael]

It really depends.

For cirrhotics, yeah I would throw their MELD in as part of the one liner - "this is a 54 year old man with a history of etoh cirrhosis, MELD 24"

Because that's a very quick way of telling someone how sick that patient is.

But of the others you discuss, I would only possibly use them in my assessment/plan portion of the case - ex:

"Given this patient's CHADS2 score, long-term anticoagulation for his atrial fibrillation is indicated"

+1. That's really the only place I've mentioned them too, in my A/P.

 

[prometheus09]

It really depends.

For cirrhotics, yeah I would throw their MELD in as part of the one liner - "this is a 54 year old man with a history of etoh cirrhosis, MELD 24"

Because that's a very quick way of telling someone how sick that patient is.

But of the others you discuss, I would only possibly use them in my assessment/plan portion of the case - ex:

"Given this patient's CHADS2 score, long-term anticoagulation for his atrial fibrillation is indicated"

^Agreed.

 

[Instatewaiter]

CHADS2, Wells' Score, MELD, PSI/PORT, etc...

Is there a basic set that you always include? For example, for all suspected PE's include Wells' Score in the presentation, for all Afib's include CHADS2 score, etc..

For the primary problem include these in the assessment and plan. I don't want to hear it in the HPI and you can't put it all together until you hear the labs. So, it should go in the A&P.

It should be the primary problem to include one of these scores (with the exception of cirrhotics). For instance, person comes in with dyspepsia with a history of AF or history of PE, don't include CHADS2 or Wells unless these will somehow affect your management (say CHADS-2=0, chads-vasc=0 and patient is on coumadin for AF coming in for GI bleed, stop the coumadin b/c it's making the bleed worse and is unneeded)

The one time where these scores should be used when it is not the presenting problem is in cirrhotics. Almost all cirrhotics should have a meld even if liver failure is not their presenting problem.

 

[PddppfCl2]

Thanks for all the replies 👍. Very helpful.

 

[JJMrK]

I had one attending who wanted them in the first line of the presentation and another who didn't want to hear about them at all. Most of the time I would calculate them just in case but leave it out of the presentation (unless someone asked or it was directly related to the plan). At the end of my IM clerkship I did my best to forget everything about all of them.