# CRASH chemotherapy toxicity score CRASH Status: LIVE Price: $0.005 USDC `GET /api/calc/crash` HTML: https://magentlab.com/docs/crash Markdown: https://magentlab.com/docs/crash.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum Extermann 2012 Table 4 CRASH points into hematologic (0–6), nonhematologic (0–8), and combined (0–12, Chemotox once) scores with published four-level risk bands. ## When to use When an agent already has caller-assigned CRASH inputs for an older patient considered for chemotherapy and needs the published hematologic, nonhematologic, and combined scores, not a chemotherapy order, not CARG-TT, and not the trauma CRASH score. magent does not look up regimens or assay LDH. ## When not to use - Not a medical device. - Not a chemotherapy order. This tool does not start, stop, or choose cancer treatment. Not CARG-TT. - Not the trauma CRASH score (MRC CRASH head-injury trial). This is the Extermann 2012 Chemotherapy Risk Assessment Scale for High-Age Patients. - Hematologic, nonhematologic, and combined incidences (7/23/54/100%, 33/46/67/93%, 50/58/77/79%) are derivation-cohort observations, not patient-specific probabilities. - Chemotox is caller-assigned MAX2 (0–1). magent does not look up regimens. - Caller assigns diastolic BP, IADL (10–29), LDH and LDH ULN, ECOG, Mini-Mental Status, and Mini-Nutritional Assessment. magent does not measure blood pressure, interview, or assay LDH. - Combined score counts Chemotox once (max 12, not 14). LDH awards 0 or 2 points only (empty 1-point column in Table 4). ## Formula ``` CRASH (Extermann 2012 Table 4) hematologic = diastolic_mm_hg (<=72 0, >72 1) + iadl (26-29 0, 10-25 1) + ldh (ldh_u_l > 0.74 * ldh_uln_u_l 2 else 0; empty 1-point column) + chemotox (0-0.44 0, 0.45-0.57 1, >0.57 2); max 6; nonhematologic = ecog (0 → 0, 1-2 → 1, 3-4 → 2) + mms (30 → 0, <30 → 2) + mna (28-30 → 0, <28 → 2) + chemotox (same); max 8; combined = hematologic + nonhematologic - chemotox (count Chemotox once; max 12 not 14); H 0-1 low 7%, 2-3 medium_low 23%, 4-5 medium_high 54%, 6 high 100%; NH 0-2 low 33%, 3-4 medium_low 46%, 5-6 medium_high 67%, 7-8 high 93%; combined 0-3 low 50%, 4-6 medium_low 58%, 7-9 medium_high 77%, 10-12 high 79%; not trauma CRASH; not CARG-TT; Chemotox is caller-assigned MAX2 ``` ## Citation [Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score](https://doi.org/10.1002/cncr.26646) Extermann M, Boler I, Reich RR, et al. Cancer. 2012;118(13):3377-3386 DOI: [10.1002/cncr.26646](https://doi.org/10.1002/cncr.26646) ## Worked example ### Published worked example (combined high) Given: `chemotox=0.50, diastolic_mm_hg=80, ecog=1, iadl=20, ldh_u_l=500, ldh_uln_u_l=618, mms=28, mna=26` 1. Diastolic 80 >72 → 1; IADL 20 (10–25) → 1; LDH 500 > 0.74×618≈457.32 → 2; Chemotox 0.50 → 1. Hematologic = 5 (medium_high, 54%) 2. ECOG 1 → 1; MMS 28 <30 → 2; MNA 26 <28 → 2; Chemotox 0.50 → 1. Nonhematologic = 6 (medium_high, 67%) 3. Combined = 5+6−1 = 10 (Chemotox once; high, 79%). Not a chemotherapy order. ### All lowest Table 4 poles Given: `chemotox=0.44, diastolic_mm_hg=72, ecog=0, iadl=29, ldh_u_l=100, ldh_uln_u_l=200, mms=30, mna=30` 1. Diastolic ≤72 → 0; IADL 26–29 → 0; LDH not >0.74×ULN → 0; Chemotox 0–0.44 → 0. Hematologic = 0 (low, 7%) 2. ECOG 0 → 0; MMS 30 → 0; MNA 28–30 → 0; Chemotox 0. Nonhematologic = 0 (low, 33%) 3. Combined = 0 (low, 50%) ## Also searched as - CRASH score - CRASH chemotherapy toxicity - Extermann CRASH - Chemotherapy Risk Assessment Scale for High-Age Patients - Chemotox CRASH - MAX2 Chemotox - chemotherapy toxicity older patients - CRASH hematologic score ## Parameters - `diastolic_mm_hg` (number, required): Diastolic blood pressure in mm Hg (20-160). Extermann 2012 Table 4: ≤72 → 0, >72 → 1 hematologic point. magent does not measure blood pressure. - `iadl` (integer, required): Instrumental activities of daily living integer 10-29 (Extermann 2012 CRASH IADL). 26-29 → 0, 10-25 → 1 hematologic point. magent does not interview the patient. - `ldh_u_l` (number, required): Lactate dehydrogenase in U/L (1-20000). +2 hematologic points if ldh_u_l > 0.74 × ldh_uln_u_l, else 0 (empty 1-point column). magent does not assay LDH. - `ldh_uln_u_l` (number, required): Laboratory LDH upper limit of normal in U/L (50-2000). Used only as 0.74 × ULN for the LDH rule. No special-case ULN value. magent does not assay LDH. - `chemotox` (number, required): Caller-assigned MAX2 Chemotox from 0 to 1. 0-0.44 → 0, 0.45-0.57 → 1, >0.57 → 2. Counted once in the combined score. magent does not look up regimens. - `ecog` (integer, required): ECOG performance status integer 0-4. Extermann 2012: 0 → 0, 1-2 → 1, 3-4 → 2 nonhematologic points. magent does not assign performance status. - `mms` (integer, required): Mini-Mental Status integer 0-30. Extermann 2012: 30 → 0, <30 → 2 nonhematologic points. magent does not administer the Mini-Mental Status. - `mna` (integer, required): Mini-Nutritional Assessment integer 0-30. Extermann 2012: 28-30 → 0, <28 → 2 nonhematologic points. magent does not administer the Mini-Nutritional Assessment. ## 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/crash` 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": [ { "chemotox": "0.50", "diastolic_mm_hg": "80", "ecog": "1", "iadl": "20", "ldh_u_l": "500", "ldh_uln_u_l": "618", "mms": "28", "mna": "26" }, { "chemotox": "0.50", "diastolic_mm_hg": "80", "ecog": "1", "iadl": "20", "ldh_u_l": "500", "ldh_uln_u_l": "618", "mms": "28", "mna": "26" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/crash Example 200: ```json { "count": 2, "path": "/api/calc/crash", "items": [ { "components": [ { "value": 80.0, "factor": "diastolic_mm_hg", "points": 1, "present": true }, { "value": 20, "factor": "iadl", "points": 1, "present": true }, { "value": 500.0, "factor": "ldh", "points": 2, "present": true }, { "value": 0.5, "factor": "chemotox", "points": 1, "present": true }, { "value": 1, "factor": "ecog", "points": 1, "present": true }, { "value": 28, "factor": "mms", "points": 2, "present": true }, { "value": 26, "factor": "mna", "points": 2, "present": true } ], "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": "Extermann M, Boler I, Reich RR, et al.", "doi": "10.1002/cncr.26646", "id": "extermann-2012", "pmid": "22072065", "source": "Cancer. 2012;118(13):3377-3386", "title": "Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score" }, "formula": "crash", "formula_expression": "CRASH (Extermann 2012 Table 4) hematologic = diastolic_mm_hg (<=72 0, >72 1) + iadl (26-29 0, 10-25 1) + ldh (ldh_u_l > 0.74 * ldh_uln_u_l 2 else 0; empty 1-point column) + chemotox (0-0.44 0, 0.45-0.57 1, >0.57 2); max 6; nonhematologic = ecog (0 → 0, 1-2 → 1, 3-4 → 2) + mms (30 → 0, <30 → 2) + mna (28-30 → 0, <28 → 2) + chemotox (same); max 8; combined = hematologic + nonhematologic - chemotox (count Chemotox once; max 12 not 14); H 0-1 low 7%, 2-3 medium_low 23%, 4-5 medium_high 54%, 6 high 100%; NH 0-2 low 33%, 3-4 medium_low 46%, 5-6 medium_high 67%, 7-8 high 93%; combined 0-3 low 50%, 4-6 medium_low 58%, 7-9 medium_high 77%, 10-12 high 79%; not trauma CRASH; not CARG-TT; Chemotox is caller-assigned MAX2", "diastolic_mm_hg": 80.0, "ecog": 1, "chemotox": 0.5, "combined_incidence_percent": 79, "combined_risk": "high", "combined_score": 10, "hematologic_incidence_percent": 54, "hematologic_risk": "medium_high", "hematologic_score": 5, "iadl": 20, "ldh_u_l": 500.0, "ldh_uln_u_l": 618.0, "max_combined_score": 12, "max_hematologic_score": 6, "max_nonhematologic_score": 8, "mms": 28, "mna": 26, "nonhematologic_incidence_percent": 67, "nonhematologic_risk": "medium_high", "nonhematologic_score": 6 }, { "components": [ { "value": 80.0, "factor": "diastolic_mm_hg", "points": 1, "present": true }, { "value": 20, "factor": "iadl", "points": 1, "present": true }, { "value": 500.0, "factor": "ldh", "points": 2, "present": true }, { "value": 0.5, "factor": "chemotox", "points": 1, "present": true }, { "value": 1, "factor": "ecog", "points": 1, "present": true }, { "value": 28, "factor": "mms", "points": 2, "present": true }, { "value": 26, "factor": "mna", "points": 2, "present": true } ], "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": "Extermann M, Boler I, Reich RR, et al.", "doi": "10.1002/cncr.26646", "id": "extermann-2012", "pmid": "22072065", "source": "Cancer. 2012;118(13):3377-3386", "title": "Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score" }, "formula": "crash", "formula_expression": "CRASH (Extermann 2012 Table 4) hematologic = diastolic_mm_hg (<=72 0, >72 1) + iadl (26-29 0, 10-25 1) + ldh (ldh_u_l > 0.74 * ldh_uln_u_l 2 else 0; empty 1-point column) + chemotox (0-0.44 0, 0.45-0.57 1, >0.57 2); max 6; nonhematologic = ecog (0 → 0, 1-2 → 1, 3-4 → 2) + mms (30 → 0, <30 → 2) + mna (28-30 → 0, <28 → 2) + chemotox (same); max 8; combined = hematologic + nonhematologic - chemotox (count Chemotox once; max 12 not 14); H 0-1 low 7%, 2-3 medium_low 23%, 4-5 medium_high 54%, 6 high 100%; NH 0-2 low 33%, 3-4 medium_low 46%, 5-6 medium_high 67%, 7-8 high 93%; combined 0-3 low 50%, 4-6 medium_low 58%, 7-9 medium_high 77%, 10-12 high 79%; not trauma CRASH; not CARG-TT; Chemotox is caller-assigned MAX2", "diastolic_mm_hg": 80.0, "ecog": 1, "chemotox": 0.5, "combined_incidence_percent": 79, "combined_risk": "high", "combined_score": 10, "hematologic_incidence_percent": 54, "hematologic_risk": "medium_high", "hematologic_score": 5, "iadl": 20, "ldh_u_l": 500.0, "ldh_uln_u_l": 618.0, "max_combined_score": 12, "max_hematologic_score": 6, "max_nonhematologic_score": 8, "mms": 28, "mna": 26, "nonhematologic_incidence_percent": 67, "nonhematologic_risk": "medium_high", "nonhematologic_score": 6 } ] } ``` ## Response fields - `formula` (string): crash - `formula_expression` (string): Exact expression used - `hematologic_score` (integer): Extermann 2012 hematologic points 0-6 - `nonhematologic_score` (integer): Extermann 2012 nonhematologic points 0-8 - `combined_score` (integer): Hematologic + nonhematologic minus Chemotox once; 0-12 - `max_hematologic_score` (integer): Always 6 - `max_nonhematologic_score` (integer): Always 8 - `max_combined_score` (integer): Always 12 - `hematologic_risk` (string): low, medium_low, medium_high, or high (H-toxicity derivation split) - `nonhematologic_risk` (string): low, medium_low, medium_high, or high (non-H derivation split) - `combined_risk` (string): low, medium_low, medium_high, or high (combined derivation split) - `hematologic_incidence_percent` (integer): Derivation H-toxicity incidence 7, 23, 54, or 100; not a patient probability - `nonhematologic_incidence_percent` (integer): Derivation non-H incidence 33, 46, 67, or 93; not a patient probability - `combined_incidence_percent` (integer): Derivation combined incidence 50, 58, 77, or 79; not a patient probability - `diastolic_mm_hg` (number): Diastolic BP used, mm Hg - `iadl` (integer): IADL integer used - `ldh_u_l` (number): LDH used, U/L - `ldh_uln_u_l` (number): LDH ULN used, U/L - `chemotox` (number): Caller-assigned MAX2 Chemotox used - `ecog` (integer): ECOG used - `mms` (integer): Mini-Mental Status used - `mna` (integer): Mini-Nutritional Assessment used - `components` (array): Per-factor points with Chemotox listed once - `citation` (object): Extermann 2012 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 80.0, "factor": "diastolic_mm_hg", "points": 1, "present": true }, { "value": 20, "factor": "iadl", "points": 1, "present": true }, { "value": 500.0, "factor": "ldh", "points": 2, "present": true }, { "value": 0.5, "factor": "chemotox", "points": 1, "present": true }, { "value": 1, "factor": "ecog", "points": 1, "present": true }, { "value": 28, "factor": "mms", "points": 2, "present": true }, { "value": 26, "factor": "mna", "points": 2, "present": true } ], "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": "Extermann M, Boler I, Reich RR, et al.", "doi": "10.1002/cncr.26646", "id": "extermann-2012", "pmid": "22072065", "source": "Cancer. 2012;118(13):3377-3386", "title": "Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score" }, "formula": "crash", "formula_expression": "CRASH (Extermann 2012 Table 4) hematologic = diastolic_mm_hg (<=72 0, >72 1) + iadl (26-29 0, 10-25 1) + ldh (ldh_u_l > 0.74 * ldh_uln_u_l 2 else 0; empty 1-point column) + chemotox (0-0.44 0, 0.45-0.57 1, >0.57 2); max 6; nonhematologic = ecog (0 → 0, 1-2 → 1, 3-4 → 2) + mms (30 → 0, <30 → 2) + mna (28-30 → 0, <28 → 2) + chemotox (same); max 8; combined = hematologic + nonhematologic - chemotox (count Chemotox once; max 12 not 14); H 0-1 low 7%, 2-3 medium_low 23%, 4-5 medium_high 54%, 6 high 100%; NH 0-2 low 33%, 3-4 medium_low 46%, 5-6 medium_high 67%, 7-8 high 93%; combined 0-3 low 50%, 4-6 medium_low 58%, 7-9 medium_high 77%, 10-12 high 79%; not trauma CRASH; not CARG-TT; Chemotox is caller-assigned MAX2", "diastolic_mm_hg": 80.0, "ecog": 1, "chemotox": 0.5, "combined_incidence_percent": 79, "combined_risk": "high", "combined_score": 10, "hematologic_incidence_percent": 54, "hematologic_risk": "medium_high", "hematologic_score": 5, "iadl": 20, "ldh_u_l": 500.0, "ldh_uln_u_l": 618.0, "max_combined_score": 12, "max_hematologic_score": 6, "max_nonhematologic_score": 8, "mms": 28, "mna": 26, "nonhematologic_incidence_percent": 67, "nonhematologic_risk": "medium_high", "nonhematologic_score": 6 } ``` ## Errors - HTTP 400 `invalid_diastolic_bp`: diastolic_mm_hg must be a number from 20 to 160. Returned before settlement; you are not charged. - HTTP 400 `invalid_crash_iadl`: iadl must be an integer from 10 to 29 (Extermann 2012 CRASH IADL). Returned before settlement; you are not charged. - HTTP 400 `invalid_ldh`: ldh_u_l must be a number from 1 to 20000 (Extermann 2012 LDH U/L). Returned before settlement; you are not charged. - HTTP 400 `invalid_ldh_uln`: ldh_uln_u_l must be a number from 50 to 2000. Returned before settlement; you are not charged. - HTTP 400 `invalid_crash_chemotox`: chemotox must be a number from 0 to 1 (Extermann 2012 MAX2 Chemotox as assigned by the caller). Returned before settlement; you are not charged. - HTTP 400 `invalid_ecog`: ecog must be an integer from 0 to 4 (Shipp 1993 IPI). Returned before settlement; you are not charged. - HTTP 400 `invalid_crash_mms`: mms must be an integer from 0 to 30 (Extermann 2012 Mini-Mental Status). Returned before settlement; you are not charged. - HTTP 400 `invalid_crash_mna`: mna must be an integer from 0 to 30 (Extermann 2012 Mini-Nutritional Assessment). 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 - [G8](https://magentlab.com/docs/g8) — Sum the eight Bellera 2012 G8 items (seven MNA items A, B, C, E, F, H, P plus age) and return whether the published ≤14 impaired-screen cutoff is met. - [CARG-TT](https://magentlab.com/docs/carg-tt) — Sum Hurria 2011 Table 5 CARG chemotherapy-toxicity weights and return low (0-5, 30%), intermediate (6-9, 52%), or high (10-19, 83%) grade 3-5 toxicity risk. ## 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.