# Fistula Risk Score after pancreatoduodenectomy Fistula Risk Score Status: LIVE Price: $0.005 USDC `GET /api/calc/fistula_risk` HTML: https://magentlab.com/docs/fistula-risk Markdown: https://magentlab.com/docs/fistula-risk.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Callery 2013 Fistula Risk Score from caller-assigned gland texture, pathology, pancreatic duct diameter, and estimated blood loss, and return the published 0–10 total and fistula band. ## When to use When an agent has already assigned Callery 2013 intraoperative inputs after pancreatoduodenectomy and needs the published integer FRS total and band, not a CR-POPF diagnosis, ISGPS grade, Ranson, or BISAP score. ## When not to use - Not a medical device. magent does not palpate the gland or measure EBL. Gland texture, pathology, duct diameter, and EBL are caller-assigned intraoperative values. - Intraoperative assignment: Callery 2013 is scored at pancreatoduodenectomy, not from a preoperative chart. - Does not grade CR-POPF and is not an ISGPS grade. The score is a published risk total, not a fistula diagnosis. - Not Ranson and not BISAP. This tool is the Callery 2013 Fistula Risk Score only. ## Formula ``` FRS = gland_texture (firm 0, soft 2) + pathology (pdac_or_pancreatitis 0, other 1) + duct_mm (>=5 0, >=4 1, >=3 2, >=2 3, else 4) + ebl_ml (<=400 0, <=700 1, <=1000 2, else 3); Callery 2013; max 10; negligible 0, low 1-2, intermediate 3-6, high 7-10 ``` ## Citation [A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy.](https://doi.org/10.1016/j.jamcollsurg.2012.09.002) Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM J Am Coll Surg. 2013;216(1):1-14 DOI: [10.1016/j.jamcollsurg.2012.09.002](https://doi.org/10.1016/j.jamcollsurg.2012.09.002) ## Worked example ### Firm PDAC, 5 mm duct, EBL 300 mL Given: `duct_mm=5, ebl_ml=300, gland_texture=firm, pathology=pdac_or_pancreatitis` 1. firm → 0; pdac_or_pancreatitis → 0; duct 5 mm → 0; EBL 300 → 0 2. Score = 0 (max 10); fistula_band negligible ### Soft other pathology, 1 mm duct, EBL 1100 mL Given: `duct_mm=1, ebl_ml=1100, gland_texture=soft, pathology=other` 1. soft → 2; other → 1; duct 1 mm → 4; EBL 1100 → 3 2. Score = 10 (max 10); fistula_band high ## Also searched as - Fistula Risk Score - Callery FRS - pancreatic fistula risk - CR-POPF risk score - Callery 2013 score - pancreatoduodenectomy fistula - soft pancreas fistula score ## Parameters - `gland_texture` (string, required): Caller-assigned pancreatic gland texture at pancreatoduodenectomy (Callery 2013). firm or soft. firm scores 0; soft scores 2. magent does not palpate the gland. - `pathology` (string, required): Caller-assigned pathology (Callery 2013). pdac_or_pancreatitis (pancreatic ductal adenocarcinoma or pancreatitis) scores 0. other (ampullary, duodenal, cystic, or islet cell) scores 1. - `duct_mm` (number, required): Caller-assigned pancreatic duct diameter in mm, number 0.5–20 (Callery 2013 integer-mm table). ≥5 scores 0; ≥4 scores 1; ≥3 scores 2; ≥2 scores 3; else 4 (so 4.0–4.999 scores 1; 1.5 and ≤1 score 4). magent does not measure the duct. - `ebl_ml` (number, required): Caller-assigned estimated blood loss in mL, number 0–10000 (Callery 2013). ≤400 scores 0; 401–700 scores 1; 701–1000 scores 2; >1000 scores 3. magent does not measure EBL. ## 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/fistula_risk` 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": [ { "duct_mm": "5", "ebl_ml": "300", "gland_texture": "firm", "pathology": "pdac_or_pancreatitis" }, { "duct_mm": "5", "ebl_ml": "300", "gland_texture": "firm", "pathology": "pdac_or_pancreatitis" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/fistula-risk Example 200: ```json { "count": 2, "path": "/api/calc/fistula_risk", "items": [ { "components": [ { "value": "firm", "factor": "gland_texture", "points": 0, "present": true }, { "value": "pdac_or_pancreatitis", "factor": "pathology", "points": 0, "present": true }, { "value": 5.0, "factor": "duct_mm", "points": 0, "present": true }, { "value": 300.0, "factor": "ebl_ml", "points": 0, "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": "Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM", "doi": "10.1016/j.jamcollsurg.2012.09.002", "id": "callery-2013", "pmid": "23122535", "source": "J Am Coll Surg. 2013;216(1):1-14", "title": "A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy." }, "formula": "fistula_risk", "formula_expression": "FRS = gland_texture (firm 0, soft 2) + pathology (pdac_or_pancreatitis 0, other 1) + duct_mm (>=5 0, >=4 1, >=3 2, >=2 3, else 4) + ebl_ml (<=400 0, <=700 1, <=1000 2, else 3); Callery 2013; max 10; negligible 0, low 1-2, intermediate 3-6, high 7-10", "max_score": 10, "score": 0, "duct_mm": 5.0, "ebl_ml": 300.0, "fistula_band": "negligible", "gland_texture": "firm", "pathology": "pdac_or_pancreatitis" }, { "components": [ { "value": "firm", "factor": "gland_texture", "points": 0, "present": true }, { "value": "pdac_or_pancreatitis", "factor": "pathology", "points": 0, "present": true }, { "value": 5.0, "factor": "duct_mm", "points": 0, "present": true }, { "value": 300.0, "factor": "ebl_ml", "points": 0, "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": "Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM", "doi": "10.1016/j.jamcollsurg.2012.09.002", "id": "callery-2013", "pmid": "23122535", "source": "J Am Coll Surg. 2013;216(1):1-14", "title": "A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy." }, "formula": "fistula_risk", "formula_expression": "FRS = gland_texture (firm 0, soft 2) + pathology (pdac_or_pancreatitis 0, other 1) + duct_mm (>=5 0, >=4 1, >=3 2, >=2 3, else 4) + ebl_ml (<=400 0, <=700 1, <=1000 2, else 3); Callery 2013; max 10; negligible 0, low 1-2, intermediate 3-6, high 7-10", "max_score": 10, "score": 0, "duct_mm": 5.0, "ebl_ml": 300.0, "fistula_band": "negligible", "gland_texture": "firm", "pathology": "pdac_or_pancreatitis" } ] } ``` ## Response fields - `formula` (string): fistula_risk - `formula_expression` (string): Exact expression used - `score` (integer): Callery 2013 Fistula Risk Score 0-10 - `max_score` (integer): 10 - `fistula_band` (string): Callery 2013 band: negligible (0), low (1-2), intermediate (3-6), or high (7-10). Not a CR-POPF diagnosis and not an ISGPS grade. - `gland_texture` (string): Caller-assigned gland texture used (firm or soft) - `pathology` (string): Caller-assigned pathology used (pdac_or_pancreatitis or other) - `duct_mm` (number): Pancreatic duct diameter in mm used - `ebl_ml` (number): Estimated blood loss in mL used - `components` (array): Per-factor Callery 2013 points - `citation` (object): Callery et al. J Am Coll Surg 2013 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": "firm", "factor": "gland_texture", "points": 0, "present": true }, { "value": "pdac_or_pancreatitis", "factor": "pathology", "points": 0, "present": true }, { "value": 5.0, "factor": "duct_mm", "points": 0, "present": true }, { "value": 300.0, "factor": "ebl_ml", "points": 0, "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": "Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM", "doi": "10.1016/j.jamcollsurg.2012.09.002", "id": "callery-2013", "pmid": "23122535", "source": "J Am Coll Surg. 2013;216(1):1-14", "title": "A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy." }, "formula": "fistula_risk", "formula_expression": "FRS = gland_texture (firm 0, soft 2) + pathology (pdac_or_pancreatitis 0, other 1) + duct_mm (>=5 0, >=4 1, >=3 2, >=2 3, else 4) + ebl_ml (<=400 0, <=700 1, <=1000 2, else 3); Callery 2013; max 10; negligible 0, low 1-2, intermediate 3-6, high 7-10", "max_score": 10, "score": 0, "duct_mm": 5.0, "ebl_ml": 300.0, "fistula_band": "negligible", "gland_texture": "firm", "pathology": "pdac_or_pancreatitis" } ``` ## Errors - HTTP 400 `invalid_fistula_risk`: gland_texture must be firm or soft, pathology pdac_or_pancreatitis or other, duct_mm a number 0.5-20, and ebl_ml a number 0-10000 (Callery 2013 Fistula Risk Score). 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 - [Ranson](https://magentlab.com/docs/ranson) — Sum the eleven Ranson 1974 prognostic signs (five at admission, six during the first 48 hours) and return the published mortality band. - [BISAP](https://magentlab.com/docs/bisap) — Compute the Wu 2008 BISAP score for early prediction of mortality in acute pancreatitis from BUN, caller-assigned impaired mental status, caller-assigned SIRS, age, and caller-assigned pleural effusion. ## 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.