# AWOL delirium prediction rule

AWOL

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/awol`
HTML: https://magentlab.com/docs/awol
Markdown: https://magentlab.com/docs/awol.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum the four Douglas 2013 AWOL items and return the combined-population observed delirium percent at that score.

## When to use

When an agent already has the four AWOL flags assigned and needs the published 0–4 total and Douglas 2013 combined-population observed delirium rates, not a delirium diagnosis and not CAM-ICU or 4AT.

## When not to use

- Not a medical device and not a delirium diagnosis.
- magent does not interview the patient.
- Each flag is caller-assigned. magent does not collect an integer age.
- Observed delirium percents are the Douglas 2013 combined-population rates at scores 0–4 (2/4/14/20/64). This is not a binary high-risk cutoff.
- This is Douglas 2013 AWOL only. Not CAM-ICU. Not 4AT.

## Formula

```
AWOL = age_ge_80 + failed_world_backward + not_oriented_to_place + illness_moderate_severe_or_moribund; each 1 if true; max 4; combined-population observed delirium 2/4/14/20/64% (Douglas 2013)
```

## Citation

[The AWOL tool: derivation and validation of a delirium prediction rule](https://doi.org/10.1002/jhm.2062)
Douglas VC, Hessler CS, Dhaliwal G, Betjemann JP, Fukuda KA, Alameddine LR, Lucatorto R, Johnston SC, Josephson SA
J Hosp Med. 2013;8(9):493-499
DOI: [10.1002/jhm.2062](https://doi.org/10.1002/jhm.2062)

## Worked example

### All items false

Given: `age_ge_80=false, failed_world_backward=false, illness_moderate_severe_or_moribund=false, not_oriented_to_place=false`

1. score = 0
2. observed_delirium_percent 2 (Douglas 2013 combined population)


### All four items true

Given: `age_ge_80=true, failed_world_backward=true, illness_moderate_severe_or_moribund=true, not_oriented_to_place=true`

1. score = 4
2. observed_delirium_percent 64


## Also searched as

- AWOL
- AWOL tool
- AWOL delirium
- Douglas AWOL
- age world orientation illness
- AWOL score
- delirium prediction rule
- Douglas 2013 AWOL
- AWOL WORLD backward
- nurse-rated illness AWOL

## Parameters

- `age_ge_80` (boolean, required): Age ≥80 years (AWOL A; Douglas 2013). true or false as assigned by the caller. magent does not collect an integer age and does not interview the patient.
- `failed_world_backward` (boolean, required): Unable to correctly spell WORLD backward (AWOL W; Douglas 2013). true or false as assigned by the caller. magent does not interview the patient.
- `not_oriented_to_place` (boolean, required): Not fully oriented to place: not oriented to city, state, county, hospital name, and floor (AWOL O; Douglas 2013). true or false as assigned by the caller. magent does not interview the patient.
- `illness_moderate_severe_or_moribund` (boolean, required): Nurse-rated illness severity moderately ill, severely ill, or moribund, as opposed to not ill or mildly ill (AWOL L; Douglas 2013). true or false as assigned by the caller. magent does not interview the patient.

## 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/awol`
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": [
    {
      "age_ge_80": "false",
      "failed_world_backward": "false",
      "illness_moderate_severe_or_moribund": "false",
      "not_oriented_to_place": "false"
    },
    {
      "age_ge_80": "false",
      "failed_world_backward": "false",
      "illness_moderate_severe_or_moribund": "false",
      "not_oriented_to_place": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/awol

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/awol",
  "items": [
    {
      "components": [
        {
          "factor": "age_ge_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "failed_world_backward",
          "points": 0,
          "present": false
        },
        {
          "factor": "not_oriented_to_place",
          "points": 0,
          "present": false
        },
        {
          "factor": "illness_moderate_severe_or_moribund",
          "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": "Douglas VC, Hessler CS, Dhaliwal G, Betjemann JP, Fukuda KA, Alameddine LR, Lucatorto R, Johnston SC, Josephson SA",
        "doi": "10.1002/jhm.2062",
        "id": "douglas-2013",
        "pmid": "23922253",
        "source": "J Hosp Med. 2013;8(9):493-499",
        "title": "The AWOL tool: derivation and validation of a delirium prediction rule"
      },
      "formula": "awol",
      "formula_expression": "AWOL = age_ge_80 + failed_world_backward + not_oriented_to_place + illness_moderate_severe_or_moribund; each 1 if true; max 4; combined-population observed delirium 2/4/14/20/64% (Douglas 2013)",
      "max_score": 4,
      "score": 0,
      "observed_delirium_percent": 2
    },
    {
      "components": [
        {
          "factor": "age_ge_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "failed_world_backward",
          "points": 0,
          "present": false
        },
        {
          "factor": "not_oriented_to_place",
          "points": 0,
          "present": false
        },
        {
          "factor": "illness_moderate_severe_or_moribund",
          "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": "Douglas VC, Hessler CS, Dhaliwal G, Betjemann JP, Fukuda KA, Alameddine LR, Lucatorto R, Johnston SC, Josephson SA",
        "doi": "10.1002/jhm.2062",
        "id": "douglas-2013",
        "pmid": "23922253",
        "source": "J Hosp Med. 2013;8(9):493-499",
        "title": "The AWOL tool: derivation and validation of a delirium prediction rule"
      },
      "formula": "awol",
      "formula_expression": "AWOL = age_ge_80 + failed_world_backward + not_oriented_to_place + illness_moderate_severe_or_moribund; each 1 if true; max 4; combined-population observed delirium 2/4/14/20/64% (Douglas 2013)",
      "max_score": 4,
      "score": 0,
      "observed_delirium_percent": 2
    }
  ]
}
```

## Response fields

- `formula` (string): awol
- `formula_expression` (string): Exact expression used
- `score` (integer): AWOL points 0-4
- `max_score` (integer): 4
- `observed_delirium_percent` (integer): Douglas 2013 combined-population observed delirium percent at this score: 2, 4, 14, 20, or 64. Not a diagnosis and not a binary high-risk cutoff.
- `components` (array): Per-item points
- `citation` (object): Douglas J Hosp Med 2013 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "age_ge_80",
      "points": 0,
      "present": false
    },
    {
      "factor": "failed_world_backward",
      "points": 0,
      "present": false
    },
    {
      "factor": "not_oriented_to_place",
      "points": 0,
      "present": false
    },
    {
      "factor": "illness_moderate_severe_or_moribund",
      "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": "Douglas VC, Hessler CS, Dhaliwal G, Betjemann JP, Fukuda KA, Alameddine LR, Lucatorto R, Johnston SC, Josephson SA",
    "doi": "10.1002/jhm.2062",
    "id": "douglas-2013",
    "pmid": "23922253",
    "source": "J Hosp Med. 2013;8(9):493-499",
    "title": "The AWOL tool: derivation and validation of a delirium prediction rule"
  },
  "formula": "awol",
  "formula_expression": "AWOL = age_ge_80 + failed_world_backward + not_oriented_to_place + illness_moderate_severe_or_moribund; each 1 if true; max 4; combined-population observed delirium 2/4/14/20/64% (Douglas 2013)",
  "max_score": 4,
  "score": 0,
  "observed_delirium_percent": 2
}
```

## 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

- [CAM-ICU](https://magentlab.com/docs/cam-icu) — Apply the Ely 2001 CAM-ICU algorithm and return whether delirium is present from four caller-assigned features.
- [4AT](https://magentlab.com/docs/4at) — Sum the Bellelli 2014 4AT items and return unlikely (0), possible cognitive impairment (1–3), or possible delirium (≥4).
- [AMT-4](https://magentlab.com/docs/amt-4) — Sum the four Swain 1997 AMT-4 items from caller-assigned correct/incorrect flags and return whether the score is less than 4 (impaired).
- [AMT-10](https://magentlab.com/docs/amt-10) — Sum the ten Hodkinson 1972 AMT-10 items from caller-assigned correct/incorrect flags and return the 0–10 total. Hodkinson 1972 did not publish a diagnostic cutoff.

## 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 of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- 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. HTTP 402 never includes the tool JSON.
- 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.