Burch-Wartofsky Point Scale
1. What is the main clinical purpose of the Burch-Wartofsky Point Scale?
Explanation: BWPS is used to assess the probability and severity of thyroid storm based on clinical features.
2. What BWPS score is strongly suggestive of thyroid storm?
Explanation: A BWPS score of 45 or higher is highly suggestive of thyroid storm.
3. In BWPS, what is the maximum score assignable for fever?
Explanation: Fever contributes up to 30 points, making it one of the highest-weighted criteria in BWPS.
4. Which of the following parameters is NOT directly assessed in the BWPS?
Explanation: BWPS is entirely clinical; lab thyroid hormone levels are not part of the scoring.
5. What is the maximum score assignable for tachycardia in BWPS?
Explanation: Heart rate ≥140 bpm scores 25 points in the tachycardia component of BWPS.
6. Which CNS symptom gives the highest points in BWPS?
Explanation: Seizure or coma scores 30 points under CNS effects, the maximum in that domain.
7. What GI symptom contributes the most points in BWPS?
Explanation: Jaundice contributes the highest GI/hepatic score of 20 points in the BWPS.
8. Which cardiovascular feature besides heart rate is considered in BWPS?
Explanation: The presence of atrial fibrillation adds an additional 10 points to the cardiovascular component.
9. Which of the following temperatures scores 30 points in BWPS?
Explanation: A body temperature ≥ 40.0°C (104°F) contributes 30 points under thermoregulatory dysfunction.
10. Which statement is TRUE about the BWPS?
Explanation: BWPS is a clinical scoring system, not reliant on labs, emphasizing signs/symptoms severity.
The Burch-Wartofsky Point Scale (BWPS) is a widely used clinical scoring system designed to help diagnose thyroid storm, a life-threatening complication of severe hyperthyroidism.
How it works
The BWPS assigns points based on the severity of various clinical manifestations of thyroid storm, according to the NIH. These categories include:
- Thermoregulatory Dysfunction (Temperature):Â Higher temperatures receive more points.
- Central Nervous System Effects:Â Severity ranges from agitation (mild) to seizure and coma (severe), with points increasing accordingly.
- Gastrointestinal-Hepatic Dysfunction:Â Symptoms like diarrhea, nausea, vomiting, abdominal pain, and unexplained jaundice are considered.
- Cardiovascular Dysfunction: This includes tachycardia and the presence of atrial fibrillation or congestive heart failure, says the NIH.
- Precipitating Factors:Â Such as infection, surgery, or non-compliance with medications, also contribute to the score.Â
Each symptom is assigned a point value based on its severity, and a cumulative score is calculated.
Score interpretation
- A score of 45 or greater is highly suggestive of thyroid storm.
- A score between 25 and 44 suggests impending thyroid storm.
- A score below 25 makes thyroid storm unlikely.Â
Important considerations
- The BWPS is a clinical tool, and a definitive diagnosis of thyroid storm relies on the overall clinical picture and expert judgment.
- While laboratory evidence of elevated thyroid hormone levels is often present in thyroid storm, the BWPS focuses on clinical manifestations, notes SciSpace.
- It’s important to remember that other conditions can mimic symptoms of thyroid storm, and a thorough differential diagnosis is essential, according to SciSpace.
- Other diagnostic criteria exist, such as the Japan Thyroid Association (JTA) criteria, which incorporate both clinical features and laboratory parameters, says SciSpace.Â
The Burch-Wartofsky Point Scale remains a valuable tool for early identification and management of thyroid storm, facilitating prompt treatment and potentially improving patient outcomes.
This is for informational purposes only. For medical advice or a diagnosis, consult a professional.
