Burch–Wartofsky thyroid storm score

Burch–Wartofsky

Sum Burch 1993 thyroid-storm points from temperature, CNS effects, GI-hepatic dysfunction, heart rate, heart failure, atrial fibrillation, and precipitating event and return unlikely (<25), impending (25–44), or highly suggestive (≥45).

LIVE $0.005 USDC GET /api/calc/burch_wartofsky

Markdown: /docs/burch-wartofsky.md · Canonical: https://magentlab.com/docs/burch-wartofsky

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

What it computes

When to use

When an agent needs the published Burch 1993 point total and <25 / 25–44 / ≥45 bands and must not invent a thyroid-storm diagnosis, ICU order, or a heart-rate table that starts at 99.

When not to use

Not a medical device and not a thyroid-storm diagnosis or ICU/treatment order. magent does not measure temperature or an ECG.
Temperature uses Burch 1993 Fahrenheit bins. Provide temperature_f (90–110) or temperature_c (32.2–43.3), not both. °C is converted F = C×9/5+32, then scored on the °F table.
Heart-rate bins start at 90 bpm (<90 → 0, 90–109 → 5), not 99. CNS, GI-hepatic, heart-failure grade, atrial fibrillation, and precipitating event are caller-assigned.
Bands are <25 unlikely, 25–44 impending, and ≥45 highly suggestive of thyroid storm. Score 45 is highly suggestive. The total is not a diagnosis or treatment order.

Formula

BWPS = temp_F(<99.0→0, 99.0–99.9→5, 100.0–100.9→10, 101.0–101.9→15, 102.0–102.9→20, 103.0–103.9→25, ≥104.0→30) + CNS(none→0, mild→10, moderate→20, severe→30) + GI-hepatic(none→0, moderate→10, severe→20) + HR(<90→0, 90–109→5, 110–119→10, 120–129→15, 130–139→20, ≥140→25) + HF(none→0, mild→5, moderate→10, severe→15) + 10*AF + 10*precipitant; Burch 1993; max 140; <25 unlikely, 25–44 impending, ≥45 highly_suggestive

Citation

Title: Life-threatening thyrotoxicosis. Thyroid storm
Authors: Burch HB, Wartofsky L
Source: Endocrinol Metab Clin North Am. 1993;22(2):263-277
DOI: 10.1016/S0889-8529(18)30165-8

Worked example

All zero-point bands

Given: atrial_fibrillation=falsecns_effects=nonegi_hepatic=noneheart_failure=noneheart_rate_bpm=80precipitating_event=falsetemperature_f=98.6

Temperature 98.6 °F → 0; CNS none → 0; GI none → 0; HR 80 → 0; HF none → 0; AF false → 0; precipitant false → 0
Score = 0 (max 140); bwps_band = unlikely (<25)

Heart rate ≥140 on an otherwise zero baseline

Given: atrial_fibrillation=falsecns_effects=nonegi_hepatic=noneheart_failure=noneheart_rate_bpm=140precipitating_event=falsetemperature_f=98.6

HR 140 → 25; remaining factors 0
Score = 25 (max 140); bwps_band = impending (25–44). Not a thyroid-storm diagnosis.

HR 140 plus atrial fibrillation and precipitant

Given: atrial_fibrillation=truecns_effects=nonegi_hepatic=noneheart_failure=noneheart_rate_bpm=140precipitating_event=truetemperature_f=98.6

HR 140 → 25; AF true → 10; precipitant true → 10; remaining factors 0
Score = 45 (max 140); bwps_band = highly_suggestive (≥45, not >45). Not a diagnosis or ICU order.

Also searched as

Burch Wartofsky
Burch-Wartofsky
thyroid storm score
Burch 1993
thyrotoxicosis points
thyroid storm diagnostic criteria
BWPS
life-threatening thyrotoxicosis

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/burch_wartofsky?temperature_f=98.6&cns_effects=none&gi_hepatic=none&heart_rate_bpm=80&heart_failure=none&atrial_fibrillation=false&precipitating_event=false

Full URL: https://api.magentlab.com/api/calc/burch_wartofsky?temperature_f=98.6&cns_effects=none&gi_hepatic=none&heart_rate_bpm=80&heart_failure=none&atrial_fibrillation=false&precipitating_event=false

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/burch_wartofsky?temperature_f=98.6&cns_effects=none&gi_hepatic=none&heart_rate_bpm=80&heart_failure=none&atrial_fibrillation=false&precipitating_event=false"

Parameters

Name	Type	Required	Description
`temperature_f`	number	optional	Temperature in °F (90-110). Provide this or temperature_c, not both. Burch 1993: <99.0 → 0, 99.0-99.9 → 5, 100.0-100.9 → 10, 101.0-101.9 → 15, 102.0-102.9 → 20, 103.0-103.9 → 25, ≥104.0 → 30. magent does not measure temperature.
`temperature_c`	number	optional	Temperature in °C (32.2-43.3). Converted as F = C×9/5+32, then scored on the Burch 1993 Fahrenheit table. Provide this or temperature_f, not both. magent does not measure temperature.
`cns_effects`	string	required · none, mild, moderate, severe	Caller-assigned CNS effects (Burch 1993). none → 0; mild (agitation) → 10; moderate (delirium, psychosis, extreme lethargy) → 20; severe (seizure or coma) → 30. magent does not examine the patient.
`gi_hepatic`	string	required · none, moderate, severe	Caller-assigned GI-hepatic dysfunction (Burch 1993). none → 0; moderate (diarrhea, nausea/vomiting, abdominal pain) → 10; severe (unexplained jaundice) → 20. magent does not examine the patient.
`heart_rate_bpm`	integer	required	Heart rate in beats/min (integer 30-220). Burch 1993: <90 → 0, 90-109 → 5, 110-119 → 10, 120-129 → 15, 130-139 → 20, ≥140 → 25. Bins start at 90, not 99. magent does not read an ECG.
`heart_failure`	string	required · none, mild, moderate, severe	Caller-assigned heart-failure grade (Burch 1993). none → 0; mild (pedal edema) → 5; moderate (bibasilar rales) → 10; severe (pulmonary edema) → 15. magent does not examine the patient.
`atrial_fibrillation`	boolean	required	Atrial fibrillation as assigned by the caller (true or false). Burch 1993: true → 10. magent does not read an ECG.
`precipitating_event`	boolean	required	Precipitating event as assigned by the caller (true or false). Burch 1993: true → 10. magent does not take a history.

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.

POST /api/calc/burch_wartofsky Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 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 (fixture)

{
  "items": [
    {
      "atrial_fibrillation": "false",
      "cns_effects": "none",
      "gi_hepatic": "none",
      "heart_failure": "none",
      "heart_rate_bpm": "80",
      "precipitating_event": "false",
      "temperature_f": "98.6"
    },
    {
      "atrial_fibrillation": "false",
      "cns_effects": "none",
      "gi_hepatic": "none",
      "heart_failure": "none",
      "heart_rate_bpm": "80",
      "precipitating_event": "false",
      "temperature_f": "98.6"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/burch_wartofsky",
  "items": [
    {
      "components": [
        {
          "value": 98.6,
          "factor": "temperature_f",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "cns_effects",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "gi_hepatic",
          "points": 0,
          "present": false
        },
        {
          "value": 80,
          "factor": "heart_rate_bpm",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "heart_failure",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "atrial_fibrillation",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "precipitating_event",
          "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": "Burch HB, Wartofsky L",
        "doi": "10.1016/S0889-8529(18)30165-8",
        "id": "burch-1993",
        "pmid": "8325286",
        "source": "Endocrinol Metab Clin North Am. 1993;22(2):263-277",
        "title": "Life-threatening thyrotoxicosis. Thyroid storm"
      },
      "formula": "burch_wartofsky",
      "formula_expression": "BWPS = temp_F(<99.0→0, 99.0–99.9→5, 100.0–100.9→10, 101.0–101.9→15, 102.0–102.9→20, 103.0–103.9→25, ≥104.0→30) + CNS(none→0, mild→10, moderate→20, severe→30) + GI-hepatic(none→0, moderate→10, severe→20) + HR(<90→0, 90–109→5, 110–119→10, 120–129→15, 130–139→20, ≥140→25) + HF(none→0, mild→5, moderate→10, severe→15) + 10*AF + 10*precipitant; Burch 1993; max 140; <25 unlikely, 25–44 impending, ≥45 highly_suggestive",
      "max_score": 140,
      "score": 0,
      "atrial_fibrillation": false,
      "heart_rate_bpm": 80,
      "bwps_band": "unlikely",
      "cns_effects": "none",
      "gi_hepatic": "none",
      "heart_failure": "none",
      "precipitating_event": false,
      "temperature_f": 98.6
    },
    {
      "components": [
        {
          "value": 98.6,
          "factor": "temperature_f",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "cns_effects",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "gi_hepatic",
          "points": 0,
          "present": false
        },
        {
          "value": 80,
          "factor": "heart_rate_bpm",
          "points": 0,
          "present": false
        },
        {
          "value": "none",
          "factor": "heart_failure",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "atrial_fibrillation",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "precipitating_event",
          "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": "Burch HB, Wartofsky L",
        "doi": "10.1016/S0889-8529(18)30165-8",
        "id": "burch-1993",
        "pmid": "8325286",
        "source": "Endocrinol Metab Clin North Am. 1993;22(2):263-277",
        "title": "Life-threatening thyrotoxicosis. Thyroid storm"
      },
      "formula": "burch_wartofsky",
      "formula_expression": "BWPS = temp_F(<99.0→0, 99.0–99.9→5, 100.0–100.9→10, 101.0–101.9→15, 102.0–102.9→20, 103.0–103.9→25, ≥104.0→30) + CNS(none→0, mild→10, moderate→20, severe→30) + GI-hepatic(none→0, moderate→10, severe→20) + HR(<90→0, 90–109→5, 110–119→10, 120–129→15, 130–139→20, ≥140→25) + HF(none→0, mild→5, moderate→10, severe→15) + 10*AF + 10*precipitant; Burch 1993; max 140; <25 unlikely, 25–44 impending, ≥45 highly_suggestive",
      "max_score": 140,
      "score": 0,
      "atrial_fibrillation": false,
      "heart_rate_bpm": 80,
      "bwps_band": "unlikely",
      "cns_effects": "none",
      "gi_hepatic": "none",
      "heart_failure": "none",
      "precipitating_event": false,
      "temperature_f": 98.6
    }
  ]
}

Response

Field	Type	Description
`formula`	string	burch_wartofsky
`formula_expression`	string	Exact expression used
`score`	integer	Burch 1993 points 0-140
`max_score`	integer	Always 140
`bwps_band`	string	unlikely when score is <25, impending when 25-44, highly_suggestive when ≥45 (Burch 1993). Not a thyroid-storm diagnosis or ICU/treatment order.
`temperature_f`	number	Temperature in °F used for Burch 1993 bins (converted from °C when given)
`cns_effects`	string	Caller-assigned CNS grade used
`gi_hepatic`	string	Caller-assigned GI-hepatic grade used
`heart_rate_bpm`	integer	Heart rate used, bpm
`heart_failure`	string	Caller-assigned heart-failure grade used
`atrial_fibrillation`	boolean	Atrial fibrillation flag used
`precipitating_event`	boolean	Precipitating-event flag used
`components`	array	Per-factor points
`citation`	object	Burch 1993 Endocrinol Metab Clin citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "value": 98.6,
      "factor": "temperature_f",
      "points": 0,
      "present": false
    },
    {
      "value": "none",
      "factor": "cns_effects",
      "points": 0,
      "present": false
    },
    {
      "value": "none",
      "factor": "gi_hepatic",
      "points": 0,
      "present": false
    },
    {
      "value": 80,
      "factor": "heart_rate_bpm",
      "points": 0,
      "present": false
    },
    {
      "value": "none",
      "factor": "heart_failure",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "atrial_fibrillation",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "precipitating_event",
      "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": "Burch HB, Wartofsky L",
    "doi": "10.1016/S0889-8529(18)30165-8",
    "id": "burch-1993",
    "pmid": "8325286",
    "source": "Endocrinol Metab Clin North Am. 1993;22(2):263-277",
    "title": "Life-threatening thyrotoxicosis. Thyroid storm"
  },
  "formula": "burch_wartofsky",
  "formula_expression": "BWPS = temp_F(<99.0→0, 99.0–99.9→5, 100.0–100.9→10, 101.0–101.9→15, 102.0–102.9→20, 103.0–103.9→25, ≥104.0→30) + CNS(none→0, mild→10, moderate→20, severe→30) + GI-hepatic(none→0, moderate→10, severe→20) + HR(<90→0, 90–109→5, 110–119→10, 120–129→15, 130–139→20, ≥140→25) + HF(none→0, mild→5, moderate→10, severe→15) + 10*AF + 10*precipitant; Burch 1993; max 140; <25 unlikely, 25–44 impending, ≥45 highly_suggestive",
  "max_score": 140,
  "score": 0,
  "atrial_fibrillation": false,
  "heart_rate_bpm": 80,
  "bwps_band": "unlikely",
  "cns_effects": "none",
  "gi_hepatic": "none",
  "heart_failure": "none",
  "precipitating_event": false,
  "temperature_f": 98.6
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_bwps_temperature`	temperature_f (90-110) or temperature_c (32.2-43.3) is required, not both (Burch 1993). Returned before settlement; you are not charged.
400	`invalid_cns_effects`	cns_effects must be none, mild, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
400	`invalid_gi_hepatic`	gi_hepatic must be none, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
400	`invalid_heart_rate`	heart_rate_bpm must be an integer from 30 to 220 Returned before settlement; you are not charged.
400	`invalid_heart_failure_grade`	heart_failure must be none, mild, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
400	`invalid_flag`	boolean clinical flags must be true or false Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

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MEWS — Compute the Subbe 2001 modified Early Warning Score from systolic BP, heart rate, respiratory rate, temperature, and caller-assigned AVPU.

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. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /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.