# Burch–Wartofsky thyroid storm score

Burch–Wartofsky

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

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

## What it computes

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).

## 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

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

## Worked example

### All zero-point bands

Given: `atrial_fibrillation=false, cns_effects=none, gi_hepatic=none, heart_failure=none, heart_rate_bpm=80, precipitating_event=false, temperature_f=98.6`

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


### Heart rate ≥140 on an otherwise zero baseline

Given: `atrial_fibrillation=false, cns_effects=none, gi_hepatic=none, heart_failure=none, heart_rate_bpm=140, precipitating_event=false, temperature_f=98.6`

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


### HR 140 plus atrial fibrillation and precipitant

Given: `atrial_fibrillation=true, cns_effects=none, gi_hepatic=none, heart_failure=none, heart_rate_bpm=140, precipitating_event=true, temperature_f=98.6`

1. HR 140 → 25; AF true → 10; precipitant true → 10; remaining factors 0
2. 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

## Parameters

- `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): 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): 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): 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.

Method: `POST /api/calc/burch_wartofsky`
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": [
    {
      "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"
    }
  ]
}
```

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

Example 200:

```json
{
  "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 fields

- `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

Frozen fixture. Not a live lookup.

```json
{
  "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
}
```

## Errors

- HTTP 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.
- HTTP 400 `invalid_cns_effects`: cns_effects must be none, mild, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
- HTTP 400 `invalid_gi_hepatic`: gi_hepatic must be none, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
- HTTP 400 `invalid_heart_rate`: heart_rate_bpm must be an integer from 30 to 220 Returned before settlement; you are not charged.
- HTTP 400 `invalid_heart_failure_grade`: heart_failure must be none, mild, moderate, or severe (Burch 1993). Returned before settlement; you are not charged.
- 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

- [NEWS](https://magentlab.com/docs/news) — Compute the RCP 2012 National Early Warning Score from respiratory rate, SpO2, supplemental oxygen, temperature, systolic BP, heart rate, and caller-assigned AVPU.
- [MEWS](https://magentlab.com/docs/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.

- 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.
- 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.