# Aortic dissection detection risk score (ADD-RS) ADD-RS Status: LIVE Price: $0.005 USDC `GET /api/calc/add_rs` HTML: https://magentlab.com/docs/add-rs Markdown: https://magentlab.com/docs/add-rs.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Count how many of the three Rogers 2011 ADD-RS high-risk categories have at least one marker and return the published 0 / 1 / 2-3 band. ## When to use When an agent needs the published ADD-RS category count (0–3) and must not invent an imaging order, treat the score as ADvISED D-dimer rule-out, or treat score 0 as exclusion of dissection. ## When not to use - Not a medical device. - Not an imaging order and not a diagnosis of aortic dissection. - Not the ADvISED D-dimer rule-out pathway. magent does not interpret D-dimer. - Score 0 does not exclude dissection. Rogers 2011 operationalizes the 2010 ACCF/AHA high-risk markers as three categories; two markers in one category still add only 1. - Flags are caller-assigned. magent does not examine the patient. ## Formula ``` ADD-RS = 1 if any high-risk condition (Marfan/connective tissue, family aortic disease, known aortic valve disease, recent aortic manipulation, known thoracic aneurysm) + 1 if any high-risk pain feature of chest/back/abdominal pain (sudden, severe, ripping/tearing) + 1 if any high-risk exam feature (pulse deficit or SBP differential, focal neurologic deficit with pain, new AI murmur with pain, hypotension or shock); two markers in the same category still add only 1; max 3; Rogers 2011 bands 0 / 1 / 2-3 (2010 ACCF/AHA high-risk markers) ``` ## Citation [Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection](https://doi.org/10.1161/CIRCULATIONAHA.110.988568) Rogers AM, Hermann LK, Booher AM, et al. Circulation. 2011;123(20):2213-2218 DOI: [10.1161/CIRCULATIONAHA.110.988568](https://doi.org/10.1161/CIRCULATIONAHA.110.988568) ## Worked example ### All twelve markers absent Given: `family_aortic_disease=false, focal_neuro_deficit_with_pain=false, hypotension_or_shock=false, known_aortic_valve_disease=false, known_thoracic_aneurysm=false, marfan_or_connective_tissue=false, new_ai_murmur_with_pain=false, pain_ripping_or_tearing=false, pain_severe=false, pain_sudden=false, pulse_deficit_or_sbp_differential=false, recent_aortic_manipulation=false` 1. No high-risk condition, pain, or exam marker 2. Score = 0; band 0 ### Two pain markers, no other category Given: `family_aortic_disease=false, focal_neuro_deficit_with_pain=false, hypotension_or_shock=false, known_aortic_valve_disease=false, known_thoracic_aneurysm=false, marfan_or_connective_tissue=false, new_ai_murmur_with_pain=false, pain_ripping_or_tearing=false, pain_severe=true, pain_sudden=true, pulse_deficit_or_sbp_differential=false, recent_aortic_manipulation=false` 1. Pain category present (sudden and severe still count as one category) 2. Score = 1; band 1 ## Also searched as - ADD-RS - aortic dissection detection risk score - ADD risk score - Rogers aortic dissection score - IRAD ADD-RS - thoracic aortic dissection risk score - aortic dissection high-risk markers ## Parameters - `marfan_or_connective_tissue` (boolean, required): Marfan syndrome or other connective-tissue disease (Rogers 2011 high-risk condition). true or false. Caller-assigned; magent does not diagnose a syndrome. - `family_aortic_disease` (boolean, required): Family history of aortic disease (Rogers 2011 high-risk condition). true or false. - `known_aortic_valve_disease` (boolean, required): Known aortic valve disease (Rogers 2011 high-risk condition). true or false. - `recent_aortic_manipulation` (boolean, required): Recent aortic manipulation such as catheterization or cardiac surgery (Rogers 2011 high-risk condition). true or false. - `known_thoracic_aneurysm` (boolean, required): Known thoracic aortic aneurysm (Rogers 2011 high-risk condition). true or false. - `pain_sudden` (boolean, required): Chest, back, or abdominal pain of abrupt onset (Rogers 2011 high-risk pain feature). true or false. - `pain_severe` (boolean, required): Chest, back, or abdominal pain of severe intensity (Rogers 2011 high-risk pain feature). true or false. - `pain_ripping_or_tearing` (boolean, required): Chest, back, or abdominal pain described as ripping or tearing (Rogers 2011 high-risk pain feature). true or false. - `pulse_deficit_or_sbp_differential` (boolean, required): Pulse deficit or systolic blood-pressure differential (Rogers 2011 high-risk exam feature). true or false. Caller-assigned; magent does not measure pulses. - `focal_neuro_deficit_with_pain` (boolean, required): Focal neurologic deficit in conjunction with pain (Rogers 2011 high-risk exam feature). true or false. - `new_ai_murmur_with_pain` (boolean, required): New murmur of aortic insufficiency in conjunction with pain (Rogers 2011 high-risk exam feature). true or false. Caller-assigned; magent does not auscultate. - `hypotension_or_shock` (boolean, required): Hypotension or shock state (Rogers 2011 high-risk exam feature). true or false. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/add_rs` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "family_aortic_disease": "false", "focal_neuro_deficit_with_pain": "false", "hypotension_or_shock": "false", "known_aortic_valve_disease": "false", "known_thoracic_aneurysm": "false", "marfan_or_connective_tissue": "false", "new_ai_murmur_with_pain": "false", "pain_ripping_or_tearing": "false", "pain_severe": "false", "pain_sudden": "false", "pulse_deficit_or_sbp_differential": "false", "recent_aortic_manipulation": "false" }, { "family_aortic_disease": "false", "focal_neuro_deficit_with_pain": "false", "hypotension_or_shock": "false", "known_aortic_valve_disease": "false", "known_thoracic_aneurysm": "false", "marfan_or_connective_tissue": "false", "new_ai_murmur_with_pain": "false", "pain_ripping_or_tearing": "false", "pain_severe": "false", "pain_sudden": "false", "pulse_deficit_or_sbp_differential": "false", "recent_aortic_manipulation": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/add-rs Example 200: ```json { "count": 2, "path": "/api/calc/add_rs", "items": [ { "components": [ { "factor": "high_risk_conditions", "points": 0, "present": false }, { "factor": "high_risk_pain", "points": 0, "present": false }, { "factor": "high_risk_exam", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Rogers AM, Hermann LK, Booher AM, et al.", "doi": "10.1161/CIRCULATIONAHA.110.988568", "id": "rogers-2011", "pmid": "21555704", "source": "Circulation. 2011;123(20):2213-2218", "title": "Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection" }, "formula": "add_rs", "formula_expression": "ADD-RS = 1 if any high-risk condition (Marfan/connective tissue, family aortic disease, known aortic valve disease, recent aortic manipulation, known thoracic aneurysm) + 1 if any high-risk pain feature of chest/back/abdominal pain (sudden, severe, ripping/tearing) + 1 if any high-risk exam feature (pulse deficit or SBP differential, focal neurologic deficit with pain, new AI murmur with pain, hypotension or shock); two markers in the same category still add only 1; max 3; Rogers 2011 bands 0 / 1 / 2-3 (2010 ACCF/AHA high-risk markers)", "max_score": 3, "score": 0, "add_rs_band": "0" }, { "components": [ { "factor": "high_risk_conditions", "points": 0, "present": false }, { "factor": "high_risk_pain", "points": 0, "present": false }, { "factor": "high_risk_exam", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Rogers AM, Hermann LK, Booher AM, et al.", "doi": "10.1161/CIRCULATIONAHA.110.988568", "id": "rogers-2011", "pmid": "21555704", "source": "Circulation. 2011;123(20):2213-2218", "title": "Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection" }, "formula": "add_rs", "formula_expression": "ADD-RS = 1 if any high-risk condition (Marfan/connective tissue, family aortic disease, known aortic valve disease, recent aortic manipulation, known thoracic aneurysm) + 1 if any high-risk pain feature of chest/back/abdominal pain (sudden, severe, ripping/tearing) + 1 if any high-risk exam feature (pulse deficit or SBP differential, focal neurologic deficit with pain, new AI murmur with pain, hypotension or shock); two markers in the same category still add only 1; max 3; Rogers 2011 bands 0 / 1 / 2-3 (2010 ACCF/AHA high-risk markers)", "max_score": 3, "score": 0, "add_rs_band": "0" } ] } ``` ## Response fields - `formula` (string): add_rs - `formula_expression` (string): Exact expression used - `score` (integer): Category count 0-3 - `max_score` (integer): 3 - `add_rs_band` (string): Rogers 2011 band 0, 1, or 2-3. Not an imaging order. - `components` (array): One row per high-risk category (conditions, pain, exam), 0 or 1 each - `citation` (object): Rogers 2011 IRAD citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "high_risk_conditions", "points": 0, "present": false }, { "factor": "high_risk_pain", "points": 0, "present": false }, { "factor": "high_risk_exam", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Rogers AM, Hermann LK, Booher AM, et al.", "doi": "10.1161/CIRCULATIONAHA.110.988568", "id": "rogers-2011", "pmid": "21555704", "source": "Circulation. 2011;123(20):2213-2218", "title": "Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection" }, "formula": "add_rs", "formula_expression": "ADD-RS = 1 if any high-risk condition (Marfan/connective tissue, family aortic disease, known aortic valve disease, recent aortic manipulation, known thoracic aneurysm) + 1 if any high-risk pain feature of chest/back/abdominal pain (sudden, severe, ripping/tearing) + 1 if any high-risk exam feature (pulse deficit or SBP differential, focal neurologic deficit with pain, new AI murmur with pain, hypotension or shock); two markers in the same category still add only 1; max 3; Rogers 2011 bands 0 / 1 / 2-3 (2010 ACCF/AHA high-risk markers)", "max_score": 3, "score": 0, "add_rs_band": "0" } ``` ## Errors - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [HEART score](https://magentlab.com/docs/heart) — Compute the HEART score as age points plus caller-assigned history, ECG, risk factors, and troponin (each 0-2). - [EDACS](https://magentlab.com/docs/edacs) — Compute the Than 2014 Emergency Department Assessment of Chest pain Score from age, sex, and caller-assigned flags. - [Killip](https://magentlab.com/docs/killip) — Return the Killip and Kimball 1967 myocardial-infarction heart-failure class 1-4 from a caller-assigned integer, with the published class description and 1967 CCU hospital mortality. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON echoing accepted, payload, and extensions when present). - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.