# EGSYS score

EGSYS

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

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

## What it computes

Sum the six Del Rosso 2008 EGSYS flags and return whether the total is ≥3 (published cardiac-syncope triage discriminator).

## When to use

When an agent needs the published EGSYS point total from caller-assigned flags and must not invent a syncope history or a cardiac-syncope diagnosis.

## When not to use

- Not a medical device. Not a cardiac-syncope diagnosis, disposition, or admission order.
- Only the Del Rosso 2008 discriminator (score ≥3 versus <3) is returned. magent does not invent other cutoffs.
- The caller assigns the six flags. magent does not take a history, read an ECG, or diagnose heart disease.

## Formula

```
EGSYS = 4*palpitations + 3*abnormal_ecg_or_heart_disease + 3*syncope_during_effort + 2*syncope_supine - 1*no_autonomic_prodromes - 1*no_precipitating_factors; range -2 to 12; score_ge_3 iff total >= 3 (Del Rosso 2008)
```

## Citation

[Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score](https://doi.org/10.1136/hrt.2008.143123)
Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M
Heart. 2008;94(12):1620-1626
DOI: [10.1136/hrt.2008.143123](https://doi.org/10.1136/hrt.2008.143123)

## Worked example

### All six flags false

Given: `abnormal_ecg_or_heart_disease=false, no_autonomic_prodromes=false, no_precipitating_factors=false, palpitations=false, syncope_during_effort=false, syncope_supine=false`

1. Each flag false → 0
2. Score = 0 (max 12); score_ge_3 false (below the ≥3 discriminator)


### Palpitations plus absence of autonomic prodromes (score 3)

Given: `abnormal_ecg_or_heart_disease=false, no_autonomic_prodromes=true, no_precipitating_factors=false, palpitations=true, syncope_during_effort=false, syncope_supine=false`

1. palpitations → +4; no_autonomic_prodromes → −1; remaining flags 0
2. Score = 3 (max 12); score_ge_3 true (Del Rosso 2008 ≥3 discriminator)


## Also searched as

- EGSYS score
- Evaluation of Guidelines in Syncope Study
- Del Rosso syncope score
- EGSYS cardiac syncope
- syncope EGSYS 2008
- hospital syncope score EGSYS

## Parameters

- `palpitations` (boolean, required): Palpitations preceding syncope (Del Rosso 2008, +4). true or false as assigned by the caller. magent does not take a history.
- `abnormal_ecg_or_heart_disease` (boolean, required): Abnormal ECG and/or heart disease (Del Rosso 2008, +3). true or false as assigned by the caller. magent does not read an ECG.
- `syncope_during_effort` (boolean, required): Syncope during effort (Del Rosso 2008, +3). true or false as assigned by the caller.
- `syncope_supine` (boolean, required): Syncope while supine (Del Rosso 2008, +2). true or false as assigned by the caller.
- `no_autonomic_prodromes` (boolean, required): Absence of autonomic prodromes (Del Rosso 2008, −1). true or false as assigned by the caller.
- `no_precipitating_factors` (boolean, required): Absence of predisposing and/or precipitating factors (Del Rosso 2008, −1). true or false as assigned by the caller.

## 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/egsys`
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": [
    {
      "abnormal_ecg_or_heart_disease": "false",
      "no_autonomic_prodromes": "false",
      "no_precipitating_factors": "false",
      "palpitations": "false",
      "syncope_during_effort": "false",
      "syncope_supine": "false"
    },
    {
      "abnormal_ecg_or_heart_disease": "false",
      "no_autonomic_prodromes": "false",
      "no_precipitating_factors": "false",
      "palpitations": "false",
      "syncope_during_effort": "false",
      "syncope_supine": "false"
    }
  ]
}
```

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

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/egsys",
  "items": [
    {
      "components": [
        {
          "factor": "palpitations",
          "points": 0,
          "present": false
        },
        {
          "factor": "abnormal_ecg_or_heart_disease",
          "points": 0,
          "present": false
        },
        {
          "factor": "syncope_during_effort",
          "points": 0,
          "present": false
        },
        {
          "factor": "syncope_supine",
          "points": 0,
          "present": false
        },
        {
          "factor": "no_autonomic_prodromes",
          "points": 0,
          "present": false
        },
        {
          "factor": "no_precipitating_factors",
          "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": "Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M",
        "doi": "10.1136/hrt.2008.143123",
        "id": "del-rosso-2008",
        "pmid": "18519550",
        "source": "Heart. 2008;94(12):1620-1626",
        "title": "Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score"
      },
      "formula": "egsys",
      "formula_expression": "EGSYS = 4*palpitations + 3*abnormal_ecg_or_heart_disease + 3*syncope_during_effort + 2*syncope_supine - 1*no_autonomic_prodromes - 1*no_precipitating_factors; range -2 to 12; score_ge_3 iff total >= 3 (Del Rosso 2008)",
      "max_score": 12,
      "score": 0,
      "score_ge_3": false
    },
    {
      "components": [
        {
          "factor": "palpitations",
          "points": 0,
          "present": false
        },
        {
          "factor": "abnormal_ecg_or_heart_disease",
          "points": 0,
          "present": false
        },
        {
          "factor": "syncope_during_effort",
          "points": 0,
          "present": false
        },
        {
          "factor": "syncope_supine",
          "points": 0,
          "present": false
        },
        {
          "factor": "no_autonomic_prodromes",
          "points": 0,
          "present": false
        },
        {
          "factor": "no_precipitating_factors",
          "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": "Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M",
        "doi": "10.1136/hrt.2008.143123",
        "id": "del-rosso-2008",
        "pmid": "18519550",
        "source": "Heart. 2008;94(12):1620-1626",
        "title": "Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score"
      },
      "formula": "egsys",
      "formula_expression": "EGSYS = 4*palpitations + 3*abnormal_ecg_or_heart_disease + 3*syncope_during_effort + 2*syncope_supine - 1*no_autonomic_prodromes - 1*no_precipitating_factors; range -2 to 12; score_ge_3 iff total >= 3 (Del Rosso 2008)",
      "max_score": 12,
      "score": 0,
      "score_ge_3": false
    }
  ]
}
```

## Response fields

- `formula` (string): egsys
- `formula_expression` (string): Exact expression used
- `score` (integer): EGSYS points -2 to 12
- `max_score` (integer): 12
- `score_ge_3` (boolean): true iff score ≥ 3 (Del Rosso 2008 cardiac-syncope triage discriminator). Not a diagnosis.
- `components` (array): Per-flag points
- `citation` (object): Del Rosso et al. Heart 2008 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "palpitations",
      "points": 0,
      "present": false
    },
    {
      "factor": "abnormal_ecg_or_heart_disease",
      "points": 0,
      "present": false
    },
    {
      "factor": "syncope_during_effort",
      "points": 0,
      "present": false
    },
    {
      "factor": "syncope_supine",
      "points": 0,
      "present": false
    },
    {
      "factor": "no_autonomic_prodromes",
      "points": 0,
      "present": false
    },
    {
      "factor": "no_precipitating_factors",
      "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": "Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M",
    "doi": "10.1136/hrt.2008.143123",
    "id": "del-rosso-2008",
    "pmid": "18519550",
    "source": "Heart. 2008;94(12):1620-1626",
    "title": "Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score"
  },
  "formula": "egsys",
  "formula_expression": "EGSYS = 4*palpitations + 3*abnormal_ecg_or_heart_disease + 3*syncope_during_effort + 2*syncope_supine - 1*no_autonomic_prodromes - 1*no_precipitating_factors; range -2 to 12; score_ge_3 iff total >= 3 (Del Rosso 2008)",
  "max_score": 12,
  "score": 0,
  "score_ge_3": false
}
```

## 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

- [San Francisco Syncope Rule](https://magentlab.com/docs/sf-syncope) — Compute the San Francisco Syncope Rule (CHESS) criterion count and rule-positive flag from published cutoffs.

## 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.