4 A’s Test for Delirium Screening

Diagnoses delirium in older patients.

4Ts Score for Heparin-Induced Thrombocytopenia

Differentiates patients with HIT from those with other causes of thrombocytopenia.

6 Minute Walk Distance

Calculates reference values for distance walked, as a measure of functional status.

A-a O₂ Gradient

Assesses for degree of shunting and V/Q mismatch.

AAP Pediatric Hypertension Guidelines

Diagnoses hypertension in pediatric patients; official guideline of the American Academy of Pediatrics.

Abbey Pain Scale for Dementia Patients

Assesses pain in patients with advanced dementia.

Abbreviated Injury Score (AIS) for Inhalation Injury

Classifies inhalation injury severity based on bronchoscopic findings.

Abbreviated Mental Test 4 (AMT-4)

Assesses mental impairment in elderly patients.

ABC Score for Massive Transfusion

Predicts need for massive transfusion in trauma patients.

ABC/2 Formula for Intracerebral Hemorrhage Volume

Predicts volume of intracranial hemorrhage from CT measurements.

ABCD² Score for TIA

Estimates the risk of stroke after a suspected transient ischemic attack (TIA).

Absolute Lymphocyte Count (ALC)

Assesses number of lymphocytes and predicts CD4 count.

Absolute Neutrophil Count (ANC)

Frequently used to assess neutropenic fever in chemotherapy patients.

Absolute Reticulocyte Count & Reticulocyte Index

Assesses appropriate response to anemia, frequently in sickle cell patients.

ACC/AHA Heart Failure Staging

Describes stages of heart failure and provides recommendations for therapy by stage.

Acetaminophen Overdose and NAC Dosing

Calculates PO/IV NAC dosing for acetaminophen overdose (and nomogram to determine toxic 4 hour level).

ACR/EULAR 2010 Rheumatoid Arthritis Classification Criteria

Diagnoses rheumatoid arthritis (RA) in patients with undifferentiated inflammatory synovitis.

ACR/EULAR Gout Classification Criteria

Provides formal diagnostic criteria for gout.

ACTION ICU Score for Intensive Care in NSTEMI

Predicts risk of NSTEMI complications requiring ICU care.

Acute Decompensated Heart Failure National Registry (ADHERE) Algorithm

Predicts in-hospital mortality in patients with heart failure (HF).

Acute Gout Diagnosis Rule

Risk stratifies for gout vs non-gout arthritis and helps determine which patients benefit most from joint aspiration.

ADAPT Protocol for Cardiac Event Risk

Assesses chest pain patients at 2 hours for risk of cardiac event.

Adult Self-Report Scale (ASRS v1.1) for ADHD

Diagnoses adult ADHD.

Age-Adjusted ESR/CRP for Rheumatoid Arthritis

Calculates age-adjusted ESR and CRP in adult patients with rheumatoid arthritis.

AIMS65 Score for Upper GI Bleeding Mortality

Determines risk of in-hospital mortality from upper GI bleeding.

Alberta Stroke Program Early CT Score (ASPECTS)

Determines MCA stroke severity using available CT data.

ALBI (Albumin-Bilirubin) Grade for Hepatocellular Carcinoma (HCC)

Predicts survival in HCC patients.

ALT-70 Score for Cellulitis

Predicts likelihood of lower extremity cellulitis over other diagnoses.

Alvarado Score for Acute Appendicitis

Likelihood of appendicitis based on symptoms, signs, and lab data.

American Diabetes Association (ADA) Risk Calculator

Predicts risk of undiagnosed diabetes to determine who should be screened.

Anion Gap

Evaluates states of metabolic acidosis.

Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP)

Stratifies severity of ankylosing spondylitis (AS) using clinical and laboratory data, specifically CRP.

Ankylosing Spondylitis Disease Activity Score with ESR (ASDAS-ESR)

Stratifies severity of ankylosing spondylitis (AS) using clinical and laboratory data, specifically ESR.

Antivenom Dosing Algorithm

Doses antivenom for pit viper snakebites.

Aortic Dissection Detection Risk Score (ADD-RS)

Rules out aortic dissection.

APACHE II Score

Estimates ICU mortality.

APGAR Score

Assesses neonates 1 and 5 minutes after birth.

Appendicitis Inflammatory Response (AIR) Score

Diagnoses appendicitis based on clinical and laboratory findings.

ARISCAT Score for Postoperative Pulmonary Complications

Predicts risk of pulmonary complications after surgery, including respiratory failure.

Arterial Blood Gas (ABG) Analyzer

Interprets ABG.

ASA Physical Status/ASA Classification

Classifies health of patients prior to surgery.

ASAS Criteria for Axial Spondyloarthritis (SpA)

Diagnoses axial spondyloarthritis according to Assessment of Spondyloarthritis International Society (ASAS) criteria.

ASAS Criteria for Peripheral SpondyloArthritis (SpA)

Diagnoses peripheral spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria.

ASCVD (Atherosclerotic Cardiovascular Disease) 2013 Risk Calculator from AHA/ACC

Determines 10-year risk of heart disease or stroke.

ASCVD (Atherosclerotic Cardiovascular Disease) Risk Algorithm including Known ASCVD from AHA/ACC

Determines 10-year risk of heart disease or stroke and provides statin recommendations.

AST to Platelet Ratio Index (APRI)

Determines the likelihood of hepatic fibrosis and cirrhosis in patients with hepatitis C.

Asthma Predictive Index (API)

Determines likelihood of pediatric patients developing childhood asthma.

ASTRAL Score for Ischemic Stroke

Predicts 90-day poor outcome in patients with acute ischemic stroke.

Asymptomatic Myeloma Prognosis

Predicts risk of progression of asymptomatic (smoldering) multiple myeloma to active myeloma or amyloidosis.

ATRIA Bleeding Risk Score

Determines bleeding risk for patients on warfarin.

ATRIA Stroke Risk Score

Determines stroke risk in patients with atrial fibrillation.

Atropine Dosing for Cholinesterase Inhibitor Toxicity

Doses atropine for cholinesterase inhibitor toxicity (prescribed drugs, nerve gas, insecticides).

AUDIT-C for Alcohol Use

Identifies at-risk drinkers (i.e., binge drinking) who may not be alcohol-dependent.

Australian Type 2 Diabetes Risk (AUSDRISK) Assessment Tool

Estimates risk of developing type 2 diabetes, mainly in Australian patients.

AWOL Score for Delirium

Predicts risk of delirium during hospitalization.

Bacterial Meningitis Score for Children

Rules out bacterial meningitis.

BAP-65 Score for Acute Exacerbation of COPD

Predicts mortality in acute COPD exacerbation.

Barnes Jewish Hospital Stroke Dysphagia Screen

Assesses ability to swallow without aspiration after stroke.

Barthel Index for Activities of Daily Living (ADL)

Assesses functional independence, generally in stroke patients.

Basal Energy Expenditure

Calculates daily energy expenditure.

Bastion Classification of Lower Limb Blast Injuries

Stratifies blast injuries of lower limbs to guide treatment.

Behavioral Observational Pain Scale (BOPS) for Post-Op Pediatric Pain

Quantifies post-operative pain for children aged 1-7 years.

Behavioral Pain Scale (BPS) for Pain Assessment in Intubated Patients

Quantifies pain in intubated patients.

Bicarbonate Deficit

Calculates the total body bicarbonate deficit.

Binet Staging System for Chronic Lymphocytic Leukemia (CLL)

Stages chronic lymphocytic leukemia, similar to Rai Staging System.

BISAP Score for Pancreatitis Mortality

Predicts mortality risk in pancreatitis with fewer variables than Ranson's.

Bishop Score for Vaginal Delivery and Induction of Labor

Predicts likelihood of successful vaginal delivery.

Blast Lung Injury Severity Score

Stratifies primary blast lung injuries into three categories to guide ventilator treatment.

Blood Volume Calculation

Calculates total blood volume, red blood cell volume, and plasma volume.

BODE Index for COPD Survival

Predicts survival in COPD patients.

Body Mass Index (BMI) and Body Surface Area (BSA)

Calculates body mass index and body surface area.

Bova Score for Pulmonary Embolism Complications

Predicts 30-day risk of PE-related complications in hemodynamically stable patients.

Braden Score for Pressure Ulcers

Identifies patients at risk for pressure ulcers.

Brief Resolved Unexplained Events (BRUE) Criteria for Infants

Classifies unexplained events and replaces the Apparent Life Threatening Events (ALTE) classification.

Bristol Stool Form Scale

Classifies stool (correlates with intestinal transit time).

Brugada Criteria for Ventricular Tachycardia

Distinguishes ventricular tachycardia from supraventricular tachycardia.

Burch-Wartofsky Point Scale (BWPS) for Thyrotoxicosis

Predicts likelihood that biochemical thyrotoxicosis is thyroid storm.

BWH Egg Freezing Counseling Tool (EFCT)

Predicts likelihood of live birth for elective egg freezing in women.

CAGE Questions for Alcohol Use

Screens for excessive drinking and alcoholism.

Calcium Correction for Hypoalbuminemia

Calculates a corrected calcium level for patients with hypoalbuminemia.

Cambridge Diabetes Risk Score

Predicts risk of having previously undiagnosed type 2 diabetes.

Canadian C-Spine Rule

Clinically clears cervical spine fracture without imaging.

Canadian Cardiovascular Society (CCS) Angina Grade

Classifies severity of angina.

Canadian CT Head Injury/Trauma Rule

Clears head injury without imaging.

Canadian Syncope Risk Score

Predicts 30-day serious adverse events in patients presenting with syncope.

Caprini Score for Venous Thromboembolism (2005)

Stratifies risk of VTE in surgical patients.

Cardiac Anesthesia Risk Evaluation Score (CARE)

Predicts mortality and morbidity after cardiac surgery.

Cardiac Output (Fick’s Formula)

Calculates cardiac output, cardiac index, and stroke volume.

CART (Cardiac Arrest Risk Triage) Score

Predicts risk of in-hospital cardiac arrest.

CATCH (Canadian Assessment of Tomography for Childhood Head injury) Rule

Predicts clinically significant head injuries in children.

CEDOCS Score for Emergency Department Overcrowding

Estimates severity of overcrowding in community emergency departments.

Centor Score (Modified/McIsaac) for Strep Pharyngitis

Estimates probability that pharyngitis is streptococcal, and suggests management course.

Cerebral Perfusion Pressure

Calculates blood flow to the brain.

CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk

Calculates stroke risk for patients with atrial fibrillation, possibly better than the CHADS₂ Score.

CHADS₂ Score for Atrial Fibrillation Stroke Risk

Estimates stroke risk in patients with atrial fibrillation.

CHALICE (Children's Head injury ALgorithm for the prediction of Important Clinical Events) Rule

Predicts death, need for neurosurgical intervention or CT abnormality in children with head trauma.

Charlson Comorbidity Index (CCI)

Predicts 10-year survival in patients with multiple comorbidities.

Child-Pugh Score for Cirrhosis Mortality

Estimates cirrhosis severity.

Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for Post-Op Pediatric Pain

Quantifies pain post-operatively in pediatric patients 1-5 years old.

CHIP (CT in Head Injury Patients) Prediction Rule

Predicts intracranial traumatic CT findings in patients with minor head trauma.

CholeS Score for Duration of Laparoscopic Cholecystectomy

Predicts operative time of laparoscopic cholecystectomy.

Cincinnati Prehospital Stroke Severity Scale (CP-SSS)

Predicts large vessel occlusion (LVO) and severe stroke in patients with stroke symptoms.

CIWA-Ar for Alcohol Withdrawal

Objectifies alcohol withdrawal severity to help guide therapy.

CKD Prediction in HIV+ Patients

Determines probability of HIV patients developing CKD in the next 5 years, if they take tenofivir or not.

CKD-EPI Equations for Glomerular Filtration Rate (GFR)

Estimates GFR based on serum creatinine, serum cystatin C, or both.

Clinical Disease Activity Index (CDAI) for Rheumatoid Arthritis

Determines severity of rheumatoid arthritis using only clinical data.

Clinical Index of Stable Febrile Neutropenia (CISNE)

Identifies febrile neutropenia patients at low risk of serious complications.

Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia (VAP)

Assists in diagnosing ventilator-associated pneumonia by predicting benefit of pulmonary cultures.

Confusion Assessment Method for the ICU (CAM-ICU)

Establishes ability to detect delirium in high risk settings.

Corrected Count Increment (CCI) for Platelet Transfusion

Assesses adequacy of response to platelet transfusion.

Corrected QT Interval (QTc)

Corrects the QT interval for heart rate extremes.

COWS Score for Opiate Withdrawal

Quantifies severity of opiate withdrawal.

Creatinine Clearance (Cockcroft-Gault Equation)

Calculates CrCl according to the Cockcroft-Gault equation.

Critical Care Pain Observation Tool (CPOT)

Rates critically ill patients’ pain based on clinical observation.

Crohn's Disease Activity Index (CDAI)

Determines the current severity of Crohn’s disease.

CRUSADE Score for Post-MI Bleeding Risk

Stratifies bleeding risk after NSTEMI.

Cryoprecipitate Dosing for Fibrinogen Replacement

Estimates volume of cryoprecipitate recommended for fibrinogen replacement.

Cumulative Illness Rating Scale-Geriatric (CIRS-G)

Quantifies burden of disease in elderly patients (comorbidity scale).

CURB-65 Score for Pneumonia Severity

Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.

Cytokine Release Syndrome (CRS) Grading

Assesses severity of CRS in patients on immunotherapy.

D'Amico Risk Classification for Prostate Cancer

Assesses 5 year risk of treatment failure based on clinical factors.

Danger Assessment Tool for Domestic Abuse

Predicts risk of death by an intimate partner (IP) in a violent intimate relationship.

DASH Prediction Score for Recurrent VTE

Predicts likelihood of recurrence of first VTE.

DECAF Score for Acute Exacerbation of COPD

Predicts in-hospital mortality in acute COPD exacerbation.

Denver HIV Risk Score

Predicts probability of undiagnosed HIV infection.

Diabetic Ketoacidosis Mortality Prediction Model (DKA MPM) Score

Predicts in-hospital mortality in DKA.

DigiFab (Digibind) Dosing for Digoxin Poisoning

Doses DigiFab in patients with confirmed digoxin poisoning or overdose.

DIPSS (Dynamic International Prognostic Scoring System) for Myelofibrosis

Estimates survival in patients with primary myelofibrosis.

DIRE Score for Opioid Treatment

Predicts compliance with opioid treatment for chronic noncancer pain.

Disease Activity Score-28 for Rheumatoid Arthritis with CRP (DAS28-CRP)

Describes severity of rheumatoid arthritis using clinical and laboratory data, specifically CRP.

Disease Activity Score-28 for Rheumatoid Arthritis with ESR (DAS28-ESR)

Describes severity of rheumatoid arthritis using clinical and laboratory data, specifically ESR.

Disease Steps for Multiple Sclerosis

Evaluates MS disease progression based on patient’s ambulatory ability.

Donor Lymphocyte Infusion (DLI) Volume

Estimates volume of whole blood to process by apheresis to yield an appropriate DLI dosage.

DRAGON Score for Post-TPA Stroke Outcome

Predicts 3 month outcome in ischemic stroke patients receiving TPA.

Drug Resistance in Pneumonia (DRIP) Score

Predicts risk for community-acquired pneumonia due to drug-resistant pathogens.

du Bois Score for Idiopathic Pulmonary Fibrosis (IPF) Mortality

Determines 1-year mortality in IPF patients using PFT and clinical indicators.

Dual Antiplatelet Therapy (DAPT) Score

Predicts which patients will benefit from prolonged DAPT after coronary stent placement.

Duke Activity Status Index (DASI)

Estimates functional capacity.

Duke Criteria for Infective Endocarditis

Diagnostic criteria for endocarditis.

Duke Treadmill Score

Diagnoses and prognoses suspected CAD based on the treadmill exercise test.

Dutch Criteria for Familial Hypercholesterolemia (FH)

Diagnoses familial hypercholesterolemia (FH) based on clinical, genetic and family history.

Duval/CIBMTR Score for Acute Myelogenous Leukemia (AML) Survival

Predicts overall survival in AML patients with relapsed/refractory disease undergoing myeloablative transplant.

Eastern Cooperative Oncology Group (ECOG) Performance Status

Determines ability of patient to tolerate therapies in serious illness, specifically for chemotherapy, simpler than the Karnofsky Scale.

EGSYS (Evaluation of Guidelines in SYncope Study) Score for Syncope

Predicts likelihood that syncope is from cardiac cause.

Embolic Stroke of Undetermined Source (ESUS) Criteria

Diagnoses embolic stroke of undetermined source.

Emergency Department Assessment of Chest Pain Score (EDACS)

Identifies chest pain patients with low risk of major adverse cardiac event.

Emergency Heart Failure Mortality Risk Grade (EHMRG)

Estimates 7-day mortality of emergency CHF patients.

Endotracheal Tube (ETT) Depth and Tidal Volume Calculator

Estimates depth of optimal ETT placement and target tidal volume by height.

Estimated Average Glucose (eAG) From HbA1C

Estimates an average glucose level from Hemoglobin A1C value.

Estimated Ethanol (and Toxic Alcohol) Serum Concentration Based on Ingestion

Predicts ethanol concentration based on ingestion of alcohol.

Estimated/Expected Peak Expiratory Flow (Peak Flow)

Helps to quantify asthma exacerbation severity.

EUTOS Score for Chronic Myelogenous Leukemia (CML)

Predicts outcomes after CML treatments, specifically adjusted for tyrosine kinase treatments.

Expanded Disability Status Scale (EDSS) / Functional Systems Score (FSS)

Describes severity of disability in patients with MS.

Fatty Liver Index

Diagnoses fatty liver using labs and exam findings.

Fetal Biophysical Profile (BPP) Score

Predicts need for urgent delivery based on sonographic and nonstress testing.

FeverPAIN Score for Strep Pharyngitis

Predicts likelihood of strep throat.

Fibrosis-4 (FIB-4) Index for Liver Fibrosis

Noninvasive estimate of liver scarring in HCV and HBV patients, to assess need for biopsy.

FIGO Staging for Ovarian Cancer (2014)

Stages cancer of the ovary, fallopian tube, and peritoneum.

FINDRISC (Finnish Diabetes Risk Score)

Identifies patients at high risk for type 2 diabetes.

Fisher Grading Scale for Subarachnoid Hemorrhage (SAH)

Rates risk of vasospasm in aSAH based on amount and distribution of blood on CT.

Fleischner Society Guidelines for Incidental Pulmonary Nodules

Provides guidelines for management of solid and subsolid pulmonary nodules.

Focused Assessment with Sonography for Trauma (FAST)

Predicts presence of pericardial or intra-abdominal injury after penetrating or blunt trauma.

Follicular Lymphoma International Prognostic Index (FLIPI)

Estimates overall survival based on clinical information.

Fomepizole Dosing

Doses fomepizole for methanol and ethylene glycol reversal.

Fong Clinical Risk Score for Colorectal Cancer Recurrence

Predicts recurrence for colorectal cancer patients with liver metastasis after hepatic resection.

Forrest Classification of Upper GI Bleeding

Stratifies severity of upper GI bleeding according to endoscopic findings.

FOUR (Full Outline of UnResponsiveness) Score

Grades coma severity; may be more accurate than the Glasgow Coma Scale.

Fractional Excretion of Sodium (FENa)

Determines if renal failure is due to pre-renal, intrinsic, or post-renal pathology.

Fractional Excretion of Urea (FEUrea)

Determines the cause of renal failure. Similar to the FENa, but can be used on patients on diuretics.

Framingham Coronary Heart Disease Risk Score

Estimates risk of heart attack in 10 years.

Framingham Heart Failure Diagnostic Criteria

Diagnoses heart failure based on major and minor criteria.

Free Water Deficit in Hypernatremia

Calculates free water deficit by estimated total body water.

Fuhrman Nuclear Grade for Clear Cell Renal Carcinoma

Provides prognostic grading system for tumor cells based on physical cellular appearance.

Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score

Identifies patients with ICH who will attain functional independence and assists in clinical decision-making.

GAD-7 (General Anxiety Disorder-7)

Measures severity of anxiety.

Gail Model for Breast Cancer Risk

Estimates risk for breast cancer based on demographic and clinical data.

GALAD Model for Hepatocellular Carcinoma (HCC)

Diagnoses HCC based on serum biomarkers in patients with chronic liver disease (CLD).

GAP Index for Idiopathic Pulmonary Fibrosis (IPF) Mortality

Provides 1, 2, and 3-year mortality estimates for IPF patients.

Geneva Risk Score for Venous Thromboembolism (VTE) Prophylaxis

Predicts need for VTE prophylaxis in admitted patients.

Geneva Score (Revised) for Pulmonary Embolism

Objectifies risk of PE, like Wells’ score.

Glasgow Alcoholic Hepatitis Score

Predicts mortality in patients with alcoholic hepatitis by lab results and age.

Glasgow Coma Scale/Score (GCS)

Coma severity based on Eye (4), Verbal (5), and Motor (6) criteria.

Glasgow Prognostic Score (GPS) for Cancer Outcomes

Provides cancer prognosis based on serum biomarkers.

Glasgow-Blatchford Bleeding Score (GBS)

Stratifies upper GI bleeding patients who are “low-risk” and candidates for outpatient management.

Glasgow-Imrie Criteria for Severity of Acute Pancreatitis

Determines severity of pancreatitis based on 8 laboratory values.

Gleason Score for Prostate Cancer

Prognoses prostate cancer based on microscopic tumor appearance.

Global Initiative for Obstructive Lung Disease (GOLD) Criteria for COPD

Assesses different stages of COPD and provides treatment recommendations.

GO-FAR (Good Outcome Following Attempted Resuscitation) Score

Predicts survival to discharge with good outcome after in-hospital cardiac arrest.

GRACE ACS Risk and Mortality Calculator

Estimates admission-6 month mortality for patients with acute coronary syndrome.

Groupe d'Etude des Lymphomes Folliculaires (GELF) Criteria

Determines if immediate therapy for follicular lymphoma is required.

Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA)

Predicts risk of MI or cardiac arrest after surgery.

GWTG-Heart Failure Risk Score

Predicts in-hospital all-cause heart failure mortality.

Hamilton Anxiety Scale

Rates level of anxiety based on clinical questions.

Hamilton Depression Rating Scale (HAM-D)

Stratifies severity of depression, similar to PHQ-9.

Harmless Acute Pancreatitis Score (HAPS)

Identifies patients who do not require intensive care for their first episode of acute pancreatitis.

HAS-BLED Score for Major Bleeding Risk

Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in atrial fibrillation care.

HAT (Hemorrhage After Thrombolysis) Score for Predicting Post-tPA Hemorrhage

Assesses hemorrhage risk after tPA.

HEART Pathway for Early Discharge in Acute Chest Pain

Identifies emergency department patients with acute chest pain for early discharge.

HEART Score for Major Cardiac Events

Predicts 6-week risk of major adverse cardiac event.

Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI)

Predicts survival after HCT in patients with hematologic malignancies, including optional age adjustment.

HEMORR₂HAGES Score for Major Bleeding Risk

Quantifies risk of hemorrhage in elderly patients with AFib.

Heng Score for Metastatic Renal Cell Carcinoma (RCC) Prognosis

Determines overall survival in patients treated with VEGF–targeted therapy.

Hepatic Encephalopathy Grades/Stages

West Haven Criteria. Defines criteria for the stages of hepatic encephalopathy.

HERDOO2 Rule for Discontinuing Anticoagulation in Unprovoked VTE

Identifies low-risk women who can safely discontinue VTE treatment.

Hestia Criteria for Outpatient Pulmonary Embolism Treatment

Identifies low-risk PE patients safe for outpatient treatment.

High-dose Insulin Euglycemia Therapy (HIET)

Doses insulin for calcium-channel blocker or beta blocker overdose.

HIT Expert Probability (HEP) Score for Heparin-Induced Thrombocytopenia

Pre-test clinical scoring model for HIT based on broad expert opinion.

HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

Quantifies HIV exposure risk by source and exposure type and need for prophylaxis.

HOMA-IR (Homeostatic Model Assessment for Insulin Resistance)

Approximates insulin resistance.

HOSPITAL Score for Readmissions

Predicts 30-day potentially avoidable hospital readmissions.

Hunt & Hess Classification of Subarachnoid Hemorrhage

Classifies severity of subarachnoid hemorrhage to predict mortality.

Hydroxychloroquine (Plaquenil) Dosing Calculator

Calculates appropriate daily dose of hydroxychloroquine to reduce risk of retinopathy.

Hypoglycemia Risk Score

Predicts 12-month risk of hypoglycemic episodes in T2DM patients.

Ideal Body Weight

Calculates ideal body weight by the Devine formula.

Immunization Schedule Calculator

Determines what immunizations/vaccinations are due based on a patient's age.

Indian Takayasu Clinical Activity Score (ITAS2010)

Differentiates between active and inactive disease in Takayasu arteritis (TA).

Infective Endocarditis (IE) Mortality Risk Score

Predicts mortality at 6 months in patients with infective endocarditis.

Injury Severity Score (ISS)

Standardizes severity of traumatic injury based on worst injury of 6 body systems.

International Prognostic Index for Chronic Lymphocytic Leukemia (CLL-IPI)

Stratifies patients with chronic lymphocytic leukemia into four risk categories.

International Prognostic Index for Diffuse Large B-cell Lymphoma (IPI and R-IPI)

Predicts overall and progression-free survival in DLBCL based on risk factors.

Intracerebral Hemorrhage (ICH) Score

Based on age and CT findings; estimates mortality.

Intraoperative Fluid Dosing in Adult Patients

Doses IV fluids intraoperatively.

Intrauterine RBC Transfusion Dosage

Estimates volume of donor RBCs need for intrauterine transfusion (IUT).

Jones Criteria for Acute Rheumatic Fever Diagnosis

Diagnoses acute rheumatic fever based on major and minor criteria.

Karnofsky Performance Status Scale

Determines ability of patient to tolerate chemotherapy.

Kawasaki Disease Diagnostic Criteria

Diagnoses Kawasaki Disease.

Khorana Risk Score for Venous Thromboembolism in Cancer Patients

Predicts risk of VTE for cancer patients depending on type of cancer and other factors.

Kidney Failure Risk Calculator

Predicts progression to kidney failure in patients with chronic kidney disease (CKD).

Killip Classification for Heart Failure

Quantifies severity of heart failure in ACS and predicts 30-day mortality.

King's College Criteria for Acetaminophen Toxicity

Recommends who should be immediately referred for liver transplant.

Kocher Criteria for Septic Arthritis

Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.

Kruis Score for Diagnosis of Irritable Bowel Syndrome (IBS)

Determines presence of IBS using clinically significant weighted criteria.

LACE Index for Readmission

Predicts 30-day readmission or death in patients on medicine and surgery wards.

Lansky Play-Performance Scale for Pediatric Functional Status

Uses parent description of child’s activity to assess ability and response to treatment.

LDL Calculated

Calculates LDL based on total and HDL cholesterol and triglycerides.

Leiden Clinical Prediction Rule for Undifferentiated Arthritis

Diagnoses rheumatoid arthritis in patients with recent-onset undifferentiated arthritis.

LENT Prognostic Score for Malignant Pleural Effusion

Predicts survival in patients with malignant pleural effusion.

Licurse Score for Renal Ultrasound

Predicts probability of hydronephrosis on renal ultrasonography (RUS) requiring urologic intervention in adult patients with acute kidney injury.

Light's Criteria for Exudative Effusions

Provides Light's Criteria to help determine if pleural fluid is exudative.

Lille Model for Alcoholic Hepatitis

Predicts mortality in patients with Alcoholic Hepatitis not responding to steroid therapy.

Los Angeles (LA) Grading of Esophagitis

Stratifies severity of esophagitis based on endoscopic findings.

Los Angeles Motor Scale (LAMS)

Stratifies stroke severity in the field.

LRINEC Score for Necrotizing Soft Tissue Infection

Screens for necrotizing soft tissue infections.

Maddrey's Discriminant Function for Alcoholic Hepatitis

Suggests which patients with alcoholic hepatitis may have a poor prognosis and benefit from steroid administration.

MAGGIC Risk Calculator for Heart Failure

Estimates 1- and 3- year mortality in heart failure.

Maintenance Fluids Calculations

Calculates maintenance fluid requirements by weight.

Major Depression Index (MDI)

Screens for depression based on clinically significant questions.

Manchester Score for Prognosis in Small Cell Lung Cancer

Predicts 2 year survival of small cell lung cancer.

Mangled Extremity Severity Score (MESS Score)

Estimates viability of an extremity after trauma, to determine need for salvage vs empiric amputation.

Manning Criteria for Diagnosis of Irritable Bowel Syndrome (IBS)

Determines likelihood of irritable bowel syndrome diagnosis based on clinically significant criteria.

Mantle Cell Lymphoma International Prognostic Index (MIPI)

Predicts survival in patients with mantle cell lymphoma.

Marburg Heart Score (MHS)

Rules out coronary artery disease in primary care patients with chest pain.

MASCC Risk Index for Febrile Neutropenia

Identifies patients at low risk for poor outcome with febrile neutropenia.

Maternal-Fetal Hemorrhage Rh(D) Immune Globulin Dosage

Calculates amount of RhIG to be administered to the mother, at the time of delivery, to prevent hemolytic disease of the fetus and newborn (HDFN).

Maximum Allowable Blood Loss (ABL) Without Transfusion

Estimates the maximum allowable blood loss intraoperatively before transfusion should be considered.

Mayo Score / Disease Activity Index (DAI) for Ulcerative Colitis

Assesses severity of ulcerative colitis.

McMahon Score for Rhabdomyolysis

Predicts mortality or acute kidney injury (AKI) in rhabdomyolysis patients.

MDRD GFR Equation

Estimates glomerular filtration rate based on creatinine and patient characteristics.

Mean Arterial Pressure (MAP)

Calculates mean arterial pressure.

Mehran Score for Post-PCI Contrast Nephropathy

Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

Mekhail Extension of the Motzer Score

Predicts metastatic renal cell carcinoma survival, more accurately than the Motzer Score.

MELD Score (Model For End-Stage Liver Disease) (12 and older)

Stratifies severity of end-stage liver disease, for transplant planning.

MELD Score (Original, Pre-2016, Model for End-Stage Liver Disease)

Calculates the MELD score to quantify end-stage liver disease for transplant planning.

MELDNa/MELD-Na Score for Liver Cirrhosis

Adds sodium to the MELD model for liver cirrhosis.

Memorial Sloan-Kettering Cancer Center (MSKCC/Motzer) Score for Metastatic Renal Cell Carcinoma (RCC)

Predicts survival based on clinical and laboratory data in metastatic RCC patients.

Metroticket Calculator for Hepatocellular Carcinoma (HCC) Survival

Predicts survival for patients with HCC.

Michigan Risk Score for PICC-Related Thrombosis

Predicts risk of DVT in patients with peripherally inserted central catheter (PICC).

Milan Criteria for Liver Transplantation

Assess suitability of patients for liver transplant with cirrhosis and hepatocellular carcinoma.

Mirels’ Criteria for Prophylactic Fixation

Predicts risk of pathologic fracture in patients with long bone metastasis.

mMRC (Modified Medical Research Council) Dyspnea Scale

Stratifies severity of dyspnea in respiratory diseases, particularly COPD.

Modified Asthma Predictive Index (mAPI)

Predicts future asthma in pediatric patients.

Modified Early Warning Score (MEWS) for Clinical Deterioration

Determines the degree of illness of a patient.

Modified Fatigue Impact Scale (MFIS)

Measures the impact fatigue takes on a patient's daily life.

Modified Fisher Grading Scale for Subarachnoid Hemorrhage (SAH)

States severity of SAH based on amount and type of blood on CT with associated vasospasm risk.

Modified Glasgow Prognostic Score (mGPS) for Cancer Outcomes

Provides improved cancer prognosis over the original score, based on serum biomarkers.

Modified Hoehn and Yahr Scale for Parkinson’s Disease

Grades severity of symptoms in Parkinson’s disease.

Modified Mallampati Classification

Stratifies difficulty of endotracheal intubation based on anatomic features.

Modified NIH Stroke Scale/Score (mNIHSS)

Shortened, validated version of the NIHSS.

Modified Rankin Scale for Neurologic Disability

Measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability.

Modified Response Evaluation Criteria in Solid Tumors (mRECIST)

Measures treatment response, specifically to cytotoxic drugs, based on tumor shrinkage.

Modified SOAR Score for Stroke

Predicts short-term mortality in acute ischemic stroke.

Multiple Myeloma International Staging System (ISS)

Prognosticates the severity of multiple myeloma based on routinely obtained lab values.

Murray Score for Acute Lung Injury

Stratifies severity of acute lung injury, and is also used for ECMO patient selection.

NAFLD (Non-Alcoholic Fatty Liver Disease) Activity Score

Diagnoses steatohepatitis, based on histology, in NAFLD patients.

NAFLD (Non-Alcoholic Fatty Liver Disease) Fibrosis Score

Estimates amount of scarring in the liver based on several laboratory tests.

Naloxone Drip Dosing

Doses naloxone for acute opioid overdose.

National Early Warning Score (NEWS)

Determines the degree of illness of a patient and prompts critical care intervention.

National Early Warning Score (NEWS) 2

Determines the degree of illness of a patient and prompts critical care intervention.

NEDOCS Score for Emergency Department Overcrowding

Estimates severity of overcrowding in emergency departments.

Neonatal Partial Exchange for Polycythemia

Estimates the volume of whole blood to remove and volume of crystalloid to infuse in neonatal polycythemia.

Neuropathy Pain Scale (NPS)

Quantifies severity of neuropathic pain.

New Orleans/Charity Head Trauma/Injury Rule

Criteria for which patients are unlikely to require imaging after head trauma.

Newsom Score for Non-traumatic Chest Pain

Rules out need for chest x-ray in chest pain patients (non-traumatic).

NEXUS Chest CT Decision Instrument for CT Imaging

Identifies blunt trauma patients with clinically significant thoracic injuries.

NEXUS Chest Decision Instrument for Blunt Chest Trauma

Determines which patients require chest imaging after blunt trauma.

NEXUS Criteria for C-Spine Imaging

Clears patients from cervical spine fracture clinically, without imaging.

NIH Stroke Scale/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.

Nonverbal Pain Scale (NVPS) for Nonverbal Patients

Quantifies pain in patients unable to speak (due to intubation, dementia, etc).

Nutrition Risk in the Critically Ill (NUTRIC) Score

Identifies critically ill patients who can benefit from nutrition therapy.

Nutrition Risk Screening 2002 (NRS-2002)

Predicts risk of malnutrition in hospitalized patients.

Oakland Score for Safe Discharge After Lower GI Bleed

Predicts readmission risk in patients with acute lower GI bleeding.

Ocular Hypertension Treatment Study (OHTS) Calculator

Identifies patients that may benefit from therapy to lower intraocular pressure (IOP).

OESIL Score for Syncope

Estimates 12-month all-cause mortality in patients presenting with syncope.

Opioid Risk Tool (ORT) for Narcotic Abuse

Estimates risk of opioid-related aberrant behaviors.

Ottawa Ankle Rule

Rules out clinically significant foot and ankle fractures to reduce use of x-ray imaging.

Ottawa Heart Failure Risk Scale (OHFRS)

Identifies ED patients with heart failure at high risk for serious adverse events.

Ottawa Knee Rule

Describes criteria for knee trauma patients so low risk as not to warrant knee imaging.

Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation

Rules out SAH in patients with headache.

Oxygenation Index

Predicts outcomes, especially in pediatric patients; helps determine need for ECMO.

Padua Prediction Score for Risk of VTE

Determines anticoagulation need in hospitalized patients by risk of VTE.

Pain Assessment in Advanced Dementia Scale (PAINAD)

Assesses pain in patients with dementia.

Palchak (UC Davis) Rule for Pediatric Head Trauma

Identifies children at low risk for brain injuries after blunt head trauma.

Parkland Formula for Burns

Calculates fluid requirements for burn patients in a 24-hour period.

PECARN Pediatric Head Injury/Trauma Algorithm

Predicts need for brain imaging after pediatric head injury.

Pediatric Appendicitis Score (PAS)

Predicts appendicitis in children.

Pediatric Asthma Score (PAS)

Stratifies asthma severity in children.

Pediatric Asthma Severity Score (PASS) for Asthma Exacerbation Severity

Determines pediatric asthma severity based on physical exam findings.

Pediatric Crohn’s Disease Activity Index (PCDAI)

Stratifies severity of Crohn’s disease in pediatric patients.

Pediatric Early Warning Score (PEWS)

Identifies pediatric patients at risk for clinical deterioration.

Pediatric Endotracheal Tube (ETT) Size

Estimates ET tube size based on age.

Pediatric Glasgow Coma Scale (pGCS)

Assesses the mental state of child patients.

Pediatric Ins and Outs

Calculates fluid status in volume per weight & volume per weight per time, for pediatrics.

Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma

Predicts need for head CT after pediatric blunt head injury, similar to PECARN.

Pediatric Respiratory Assessment Measure (PRAM) for Asthma Exacerbation Severity

Measures severity of airway obstruction in pediatric patients using clinical observations.

Pediatric SIRS, Sepsis, and Septic Shock Criteria

Defines the severity of sepsis and septic shock for pediatric patients.

Pediatric Trauma BIG Score

Stratifies severity of illness and predicts mortality in pediatric patients after trauma.

PEDIS Score for Diabetic Foot Ulcers

Predicts 6-month risk of amputation and mortality in diabetic foot ulcers.

PEDOCS Score for Pediatric Emergency Department Overcrowding

Estimates severity of overcrowding in pediatrics emergency departments.

PELD Score (Pediatric End-Stage Liver Disease) (younger than 12)

Calculates the pediatric version of the MELD score for liver cirrhosis severity and transplant planning.

PERC Rule for Pulmonary Embolism

Rules out PE if no criteria are present and pre-test probability is ≤15%.

Peripheral Blood Stem Cell Collection

Estimates CD34+ yield using pre-apheresis peripheral blood absolute CD34 blood count.

Phenytoin (Dilantin) Correction for Albumin / Renal Failure

Corrects serum phenytoin level for renal failure and/or hypoalbuminemia.

PHQ-9 (Patient Health Questionnaire-9)

Objectifies degree of depression severity.

Pittsburgh Knee Rules

Defines when knee x-rays are unnecessary, based on the Pittsburgh rules.

Pittsburgh Response to Endovascular therapy (PRE) Score

Identifies patients with anterior circulation large vessel occlusion (LVO) strokes likely to benefit from endovascular therapy.

Plasma Dosage

Doses plasma for transfusion in patients with active bleeding.

POMPE-C Tool for Pulmonary Embolism Mortality

Predicts mortality for cancer patients with PE.

POSSUM for Operative Morbidity and Mortality Risk

Estimates morbidity and mortality for general surgery patients.

Prediction of Alcohol Withdrawal Severity Scale

Screens hospitalized patients for complicated alcohol withdrawal (seizures, delirium tremens).

Pregnancy Due Dates Calculator

Calculates pregnancy dates, forward from last period or backward from due date.

Preoperative Mortality Predictor (PMP) Score

Predicts risk of perioperative mortality in general surgery patients.

Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Risk Score

Determines risk of asthma for school age children.

Prognostic Index for Cancer Outcomes

Predicts cancer mortality from serum biomarkers.

Prostate Tumor Volume & Density

Measures prostate tumor volume and PSA density.

PSI/PORT Score: Pneumonia Severity Index for CAP

Estimates mortality for adult patients with community-acquired pneumonia.

Pulmonary Embolism Severity Index (PESI)

Predicts 30-day outcome of patients with pulmonary embolism using 11 clinical criteria.

qSOFA (Quick SOFA) Score for Sepsis

Identifies high-risk patients for in-hospital mortality with suspected infection outside the ICU.

Quick Inventory of Depressive Symptomatology (QIDS)

Rates depression symptoms via self-assessment.

R Factor for Liver Injury

Differentiates cholestatic from hepatocellular liver injury.

RADS (Radiologist’s Score) for Smoke Inhalation Injury

Stratifies severity of inhalation injury on chest CT.

Rai Staging System for Chronic Lymphocytic Leukemia (CLL)

Stages chronic lymphocytic leukemia, similar to Binet Staging System.

Ranson's Criteria for Pancreatitis Mortality

Estimates mortality of patients with pancreatitis, based on initial and 48-hour lab values.

Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke

Predicts large vessel occlusion (LVO) in patients with acute stroke.

RAPID Score for Pleural Infection

Predicts mortality in patients with pleural infection.

Rapid Shallow Breathing Index (RSBI)

Predicts successful extubation, to be used only as a single component of the clinical picture.

RBC Units to Screen for Compatibility

Estimates number of donor RBC units to screen to obtain a desired number of antigen-negative units.

REACH-B Score for Hepatocellular Carcinoma (HCC)

Estimates risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B.

Recognition of Stroke in the Emergency Room (ROSIER) Scale

Distinguishes between acute stroke and stroke mimics.

RENAL Nephrometry Score

Categorizes renal masses by complexity for surgical decision-making.

REVEAL Registry Risk Score for Pulmonary Arterial Hypertension (PAH)

Predicts survival in patients with pulmonary arterial hypertension.

Revised Cardiac Risk Index for Pre-Operative Risk

Estimates risk of cardiac complications after noncardiac surgery.

Revised International Prognostic Scoring System (IPSS-R) for Myelodysplastic Syndrome (MDS)

Stages patients with MDS.

Revised McDonald Criteria for Multiple Sclerosis Diagnosis

Determines presence of MS using MRI findings.

Revised Multiple Myeloma International Staging System (R-ISS)

Prognostication tool for myeloma patients based on the genetics and other routinely used lab values in conjunction with the original ISS Staging System.

Revised Natural History Model for Primary Sclerosing Cholangitis

Estimates survival from primary sclerosing cholangitis.

Revised Original Score for Autoimmune Hepatitis (AIH)

Revised version of the original scoring system for the diagnosis of autoimmune hepatitis.

Revised Schwartz Equation for Glomerular Filtration Rate (GFR) (2009)

Estimates GFR in pediatric patients.

Revised Trauma Score

Quantifies severity of trauma injuries based on GCS, blood pressure, and respiratory rate.

Revised Urinary Incontinence Scale (RUIS)

Assesses urinary incontinence symptoms and monitors outcomes with treatment.

Reynolds Risk Score for Cardiovascular Risk in Women

Estimates 10-year cardiovascular risk in women over age 45 years.

Richmond Agitation-Sedation Scale (RASS)

Ranks agitation and possibility for sedation.

RIETE Score for Risk of Hemorrhage in Pulmonary Embolism Treatment

Determine the risk of major bleeding during anticoagulant therapy.

RIPASA Score for Acute Appendicitis

Diagnoses appendicitis with lab values and clinical findings, especially for Asian populations.

Risk of Malignancy Index (RMI) for Ovarian Cancer

Predicts risk that an adnexal mass is malignant.

Risk of Paradoxical Embolism (RoPE) Score

Identifies stroke-related PFO in patients with cryptogenic stroke.

Risk Score for Asthma Exacerbation (RSE)

Predicts likelihood of asthma exacerbation within 6 months.

Rochester Criteria for Febrile Infants

Determines whether febrile infants are low risk for serious bacterial infection.

Rockall Score for Upper GI Bleeding (Complete)

Determines severity of GI bleeding.

Rockall Score for Upper GI Bleeding (Pre-Endoscopy)

Determines severity of GI bleeding, prior to endoscopy.

Rome II Diagnostic Criteria for Irritable Bowel Syndrome (IBS)

Provides criteria for diagnosis of irritable bowel syndrome (IBS) within 3 month period.

Rome III Diagnostic Criteria for Irritable Bowel Syndrome (IBS)

Provides criteria for diagnosis of irritable bowel syndrome (IBS) within 12 week period.

Rome IV Diagnostic Criteria for Constipation

Provides criteria for diagnosis of functional constipation.

Rome IV Diagnostic Criteria for Dyspepsia

Provides criteria for diagnosis of dyspepsia.

Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)

Provides criteria for diagnosis of irritable bowel syndrome.

Rule of 7s for Lyme Meningitis

Distinguishes Lyme meningitis from aseptic meningitis.

San Francisco Syncope Rule

Defines high-risk criteria for patients with syncope.

Schwab and England Activities of Daily Living (ADL) Scale

Grades functional status in patients with Parkinson’s disease.

Secondary Intracerebral Hemorrhage (sICH) Score

Quantifies likelihood of underlying vascular etiology in patients with ICH.

SEDAN Score for Post-tPA Hemorrhage

Predicts risk of Symptomatic Intracerebral Hemorrhage (sICH) after tPA.

Sequential Organ Failure Assessment (SOFA) Score

Predicts ICU mortality based on lab results and clinical data.

Serum Ascites Albumin Gradient (SAAG)

Defines presence of portal hypertension in patients with ascites.

Serum Osmolality/Osmolarity

Calculates expected serum osmolarity, for comparison to measured osmolarity to detect unmeasured compounds in the serum.

Sgarbossa's Criteria for MI in Left Bundle Branch Block

Criteria to diagnose acute MI in patients with prior LBBB.

Shock Index

May be a more sensitive indicator of occult shock, especially in trauma or acute hemorrhage.

Shock Index, Pediatric Age-Adjusted (SIPA)

Predicts mortality in children with blunt trauma.

Shorr Score for MRSA Pneumonia

Identifies pneumonia patients at low risk for MRSA.

Shortened Modified Fatigue Impact Scale (MFIS)

Shorter version of MFIS which measures the impact fatigue takes on a patient's daily life.

Sickle Cell RBC Exchange Volume

Estimates the volume of donor RBCs needed for RBC exchange in patients with sickle cell disease.

Simon Broome Diagnostic Criteria for Familial Hypercholesterolemia (FH)

Diagnoses familial hypercholesterolemia (FH) based on clinical, genetic and family history.

Simple Disease Activity Index (SDAI) for Rheumatoid Arthritis

Determines severity of rheumatoid arthritis using clinical and laboratory data.

Simplified Acute Physiology Score (SAPS) II

Estimates mortality in ICU patients, comparable to APACHE II.

Simplified Autoimmune Hepatitis (AIH) Score

Diagnoses autoimmune hepatitis.

Simplified Motor Score (SMS)

Simplifies assessment of head trauma patients compared to the GCS.

Simplified PESI (Pulmonary Embolism Severity Index)

Predicts 30-day outcome of patients with PE, with fewer criteria than the original PESI.

SIRS, Sepsis, and Septic Shock Criteria

Defines the severity of sepsis and septic shock.

SMART-COP Score for Pneumonia Severity

Predicts need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia (CAP).

Sodium Correction for Hyperglycemia

Calculates the actual sodium level in patients with hyperglycemia.

Sodium Correction Rate in Hyponatremia and Hypernatremia

Calculates recommended fluid type, rate and volume to correct hyponatremia slowly (or more rapidly if seizing).

Sodium Deficit in Hyponatremia

Calculates sodium quantity missing in hyponatremia.

Sokal Index for Chronic Myelogenous Leukemia (CML)

Predicts survival of CML based on clinical and lab information.

SSIGN Score for Renal Cell Carcinoma (RCC)

Predicts progression of clear cell renal cell carcinoma after radical nephrectomy.

Stanford Sleepiness Scale

Quantifies subjective degrees of sleepiness.

Steinhart Model for Acute Heart Failure (AHF) in Undifferentiated Dyspnea

Diagnoses acute heart failure with NT-proBNP in undifferentiated dyspneic patients.

Step-by-Step Approach to Febrile Infants

Identifies febrile infants ≤90 days old at low risk of invasive bacterial infections.

Steroid Conversion Calculator

Converts steroid dosages using dosing equivalencies.

STONE Nephrolithometry Score for Renal Calculi

Predicts recurrence of kidney stone based on radiological criteria.

Stool Osmolar/Osmotic Gap

Determines if chronic diarrhea is osmotic or secretory in nature.