IMPROVE bleeding risk score

IMPROVE Bleed

Sum the Decousus 2011 IMPROVE admission bleeding-risk points from age, sex, renal-failure band, and eight caller-assigned flags, and return whether the published >=7 high-risk cutoff is met.

LIVE $0.005 USDC GET /api/calc/improve_bleed

Markdown: /docs/improve-bleed.md · Canonical: https://magentlab.com/docs/improve-bleed

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

What it computes

Sum the Decousus 2011 IMPROVE admission bleeding-risk points from age, sex, renal-failure band, and eight caller-assigned flags, and return whether the published >=7 high-risk cutoff is met.

When to use

When an agent needs the published Decousus 2011 IMPROVE admission bleeding-risk score (not Hostler 2016 validation, not IMPROVE VTE, not IMPROVEDD, not Padua). magent does not examine the patient and does not issue a VTE-prophylaxis order.

When not to use

Not a medical device.
Not a VTE-prophylaxis order. This tool does not recommend a drug, start pharmacologic prophylaxis, or choose mechanical prophylaxis.
Decousus 2011 derivation score only. Half-points as published (not integer-rounded). Increased bleeding risk at score >=7 from that paper. Not Hostler 2016 external validation or doubled integer weights.
Not IMPROVE VTE (Spyropoulos 2011) and not IMPROVEDD.
Age bands are mutually exclusive (<40 / 40-84 / >=85). Renal-failure bands are mutually exclusive (none / moderate / severe). magent does not compute GFR or assay INR or platelets.
magent does not examine the patient. Flags, sex, age, and renal_failure are caller-assigned.

Formula

IMPROVE bleed (Decousus 2011 admission) = active_gastroduodenal_ulcer (4.5) + prior_bleeding (4) + platelet_count_lt_50 (4) + age>=85 (3.5) + hepatic_failure INR>1.5 (2.5) + severe_renal_failure GFR<30 (2.5) + icu_ccu (2.5) + central_venous_catheter (2) + rheumatic_disease (2) + current_cancer (2) + age 40-84 (1.5) + male (1) + moderate_renal_failure GFR 30-59 (1); max 30.5; <7 not_increased, >=7 increased; half-points not integer-rounded; not Hostler 2016; not IMPROVE VTE

Citation

Title: Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators
Authors: Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, et al.
Source: Chest. 2011;139(1):69-79
DOI: 10.1378/chest.09-3081

Worked example

All lowest bands

Given: active_gastroduodenal_ulcer=falseage=35central_venous_catheter=falsecurrent_cancer=falsehepatic_failure=falseicu_ccu=falseplatelet_count_lt_50=falseprior_bleeding=falserenal_failure=nonerheumatic_disease=falsesex=female

Age 35 is <40 → 0; female → 0; renal_failure none → 0; all eight flags false → 0
Score = 0 (max 30.5); bleed_band not_increased (<7)

Active ulcer plus hepatic failure is >=7

Given: active_gastroduodenal_ulcer=trueage=35central_venous_catheter=falsecurrent_cancer=falsehepatic_failure=trueicu_ccu=falseplatelet_count_lt_50=falseprior_bleeding=falserenal_failure=nonerheumatic_disease=falsesex=female

active_gastroduodenal_ulcer → 4.5; hepatic_failure → 2.5
Score = 7 (max 30.5); bleed_band increased (>=7)

Also searched as

IMPROVE bleeding risk score
IMPROVE bleed
Decousus IMPROVE
admission bleeding risk
IMPROVE hemorrhage score
medical inpatient bleeding score
Decousus 2011 bleed
IMPROVE bleed score

Try

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

/api/calc/improve_bleed?age=35&sex=female&renal_failure=none&active_gastroduodenal_ulcer=false&prior_bleeding=false&platelet_count_lt_50=false&hepatic_failure=false&icu_ccu=false&central_venous_catheter=false&rheumatic_disease=false&current_cancer=false

Full URL: https://api.magentlab.com/api/calc/improve_bleed?age=35&sex=female&renal_failure=none&active_gastroduodenal_ulcer=false&prior_bleeding=false&platelet_count_lt_50=false&hepatic_failure=false&icu_ccu=false&central_venous_catheter=false&rheumatic_disease=false&current_cancer=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/improve_bleed?age=35&sex=female&renal_failure=none&active_gastroduodenal_ulcer=false&prior_bleeding=false&platelet_count_lt_50=false&hepatic_failure=false&icu_ccu=false&central_venous_catheter=false&rheumatic_disease=false&current_cancer=false"

Parameters

Name	Type	Required	Description
`age`	integer	required	Age in years (18-120). Decousus 2011 bands: <40 scores 0, 40-84 scores 1.5, >=85 scores 3.5. Age 39 scores 0; age 40 scores 1.5; age 84 scores 1.5; age 85 scores 3.5. Bands are mutually exclusive.
`sex`	string	required	male or female (Decousus 2011). Male scores 1; female scores 0. magent does not examine the patient.
`renal_failure`	string	required	none, moderate, or severe as assigned by the caller (Decousus 2011). none is GFR >=60 mL/min/m2 (0 points); moderate is GFR 30-59 (1 point); severe is GFR <30 (2.5 points). Bands are mutually exclusive. magent does not compute GFR.
`active_gastroduodenal_ulcer`	boolean	required	Active gastroduodenal ulcer as assigned by the caller (Decousus 2011). true or false. 4.5 points if true. magent does not examine the patient.
`prior_bleeding`	boolean	required	Bleeding during the 3 months before admission as assigned by the caller (Decousus 2011). true or false. 4 points if true. magent does not take a bleeding history.
`platelet_count_lt_50`	boolean	required	Platelet count <50 x 10^9/L at admission as assigned by the caller (Decousus 2011). true or false. 4 points if true. magent does not assay platelets.
`hepatic_failure`	boolean	required	Hepatic failure (INR >1.5) as assigned by the caller (Decousus 2011). true or false. 2.5 points if true. magent does not assay INR.
`icu_ccu`	boolean	required	ICU or CCU stay as assigned by the caller (Decousus 2011). true or false. 2.5 points if true. magent does not assign level of care.
`central_venous_catheter`	boolean	required	Central venous catheter as assigned by the caller (Decousus 2011). true or false. 2 points if true. magent does not examine the patient.
`rheumatic_disease`	boolean	required	Rheumatic disease as assigned by the caller (Decousus 2011). true or false. 2 points if true. magent does not diagnose rheumatic disease.
`current_cancer`	boolean	required	Current cancer as assigned by the caller (Decousus 2011). true or false. 2 points if true. magent does not diagnose cancer.

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/improve_bleed 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": [
    {
      "active_gastroduodenal_ulcer": "false",
      "age": "35",
      "central_venous_catheter": "false",
      "current_cancer": "false",
      "hepatic_failure": "false",
      "icu_ccu": "false",
      "platelet_count_lt_50": "false",
      "prior_bleeding": "false",
      "renal_failure": "none",
      "rheumatic_disease": "false",
      "sex": "female"
    },
    {
      "active_gastroduodenal_ulcer": "false",
      "age": "35",
      "central_venous_catheter": "false",
      "current_cancer": "false",
      "hepatic_failure": "false",
      "icu_ccu": "false",
      "platelet_count_lt_50": "false",
      "prior_bleeding": "false",
      "renal_failure": "none",
      "rheumatic_disease": "false",
      "sex": "female"
    }
  ]
}

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/improve_bleed",
  "items": [
    {
      "components": [
        {
          "factor": "active_gastroduodenal_ulcer",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "prior_bleeding",
          "points": 0,
          "present": false
        },
        {
          "factor": "platelet_count_lt_50",
          "points": 0,
          "present": false
        },
        {
          "value": 35,
          "factor": "age_ge_85",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "hepatic_failure",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "severe_renal_failure",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "icu_ccu",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "central_venous_catheter",
          "points": 0,
          "present": false
        },
        {
          "factor": "rheumatic_disease",
          "points": 0,
          "present": false
        },
        {
          "factor": "current_cancer",
          "points": 0,
          "present": false
        },
        {
          "value": 35,
          "factor": "age_40_84",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "male_sex",
          "points": 0,
          "present": false
        },
        {
          "factor": "moderate_renal_failure",
          "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": "Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, et al.",
        "doi": "10.1378/chest.09-3081",
        "id": "decousus-2011",
        "pmid": "20453069",
        "source": "Chest. 2011;139(1):69-79",
        "title": "Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators"
      },
      "formula": "improve_bleed",
      "formula_expression": "IMPROVE bleed (Decousus 2011 admission) = active_gastroduodenal_ulcer (4.5) + prior_bleeding (4) + platelet_count_lt_50 (4) + age>=85 (3.5) + hepatic_failure INR>1.5 (2.5) + severe_renal_failure GFR<30 (2.5) + icu_ccu (2.5) + central_venous_catheter (2) + rheumatic_disease (2) + current_cancer (2) + age 40-84 (1.5) + male (1) + moderate_renal_failure GFR 30-59 (1); max 30.5; <7 not_increased, >=7 increased; half-points not integer-rounded; not Hostler 2016; not IMPROVE VTE",
      "max_score": 30.5,
      "score": 0.0,
      "age_years": 35,
      "sex": "female",
      "bleed_band": "not_increased",
      "renal_failure": "none"
    },
    {
      "components": [
        {
          "factor": "active_gastroduodenal_ulcer",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "prior_bleeding",
          "points": 0,
          "present": false
        },
        {
          "factor": "platelet_count_lt_50",
          "points": 0,
          "present": false
        },
        {
          "value": 35,
          "factor": "age_ge_85",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "hepatic_failure",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "severe_renal_failure",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "icu_ccu",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "central_venous_catheter",
          "points": 0,
          "present": false
        },
        {
          "factor": "rheumatic_disease",
          "points": 0,
          "present": false
        },
        {
          "factor": "current_cancer",
          "points": 0,
          "present": false
        },
        {
          "value": 35,
          "factor": "age_40_84",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "male_sex",
          "points": 0,
          "present": false
        },
        {
          "factor": "moderate_renal_failure",
          "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": "Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, et al.",
        "doi": "10.1378/chest.09-3081",
        "id": "decousus-2011",
        "pmid": "20453069",
        "source": "Chest. 2011;139(1):69-79",
        "title": "Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators"
      },
      "formula": "improve_bleed",
      "formula_expression": "IMPROVE bleed (Decousus 2011 admission) = active_gastroduodenal_ulcer (4.5) + prior_bleeding (4) + platelet_count_lt_50 (4) + age>=85 (3.5) + hepatic_failure INR>1.5 (2.5) + severe_renal_failure GFR<30 (2.5) + icu_ccu (2.5) + central_venous_catheter (2) + rheumatic_disease (2) + current_cancer (2) + age 40-84 (1.5) + male (1) + moderate_renal_failure GFR 30-59 (1); max 30.5; <7 not_increased, >=7 increased; half-points not integer-rounded; not Hostler 2016; not IMPROVE VTE",
      "max_score": 30.5,
      "score": 0.0,
      "age_years": 35,
      "sex": "female",
      "bleed_band": "not_increased",
      "renal_failure": "none"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	improve_bleed
`formula_expression`	string	Exact expression used
`score`	number	Decousus 2011 IMPROVE bleed points 0-30.5 (half-points allowed; not integer-rounded)
`max_score`	number	Always 30.5
`bleed_band`	string	not_increased when score is <7, increased when score is >=7 (Decousus 2011 derivation). Not a VTE-prophylaxis order.
`age_years`	integer	Age used for the <40 / 40-84 / >=85 bands
`sex`	string	female or male
`renal_failure`	string	none, moderate, or severe as supplied
`components`	array	Per-factor points
`citation`	object	Decousus 2011 citation
`disclaimer`	string	Not-a-device notice

Example JSON

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

{
  "components": [
    {
      "factor": "active_gastroduodenal_ulcer",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "prior_bleeding",
      "points": 0,
      "present": false
    },
    {
      "factor": "platelet_count_lt_50",
      "points": 0,
      "present": false
    },
    {
      "value": 35,
      "factor": "age_ge_85",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "hepatic_failure",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "severe_renal_failure",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "icu_ccu",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "central_venous_catheter",
      "points": 0,
      "present": false
    },
    {
      "factor": "rheumatic_disease",
      "points": 0,
      "present": false
    },
    {
      "factor": "current_cancer",
      "points": 0,
      "present": false
    },
    {
      "value": 35,
      "factor": "age_40_84",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "male_sex",
      "points": 0,
      "present": false
    },
    {
      "factor": "moderate_renal_failure",
      "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": "Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, et al.",
    "doi": "10.1378/chest.09-3081",
    "id": "decousus-2011",
    "pmid": "20453069",
    "source": "Chest. 2011;139(1):69-79",
    "title": "Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators"
  },
  "formula": "improve_bleed",
  "formula_expression": "IMPROVE bleed (Decousus 2011 admission) = active_gastroduodenal_ulcer (4.5) + prior_bleeding (4) + platelet_count_lt_50 (4) + age>=85 (3.5) + hepatic_failure INR>1.5 (2.5) + severe_renal_failure GFR<30 (2.5) + icu_ccu (2.5) + central_venous_catheter (2) + rheumatic_disease (2) + current_cancer (2) + age 40-84 (1.5) + male (1) + moderate_renal_failure GFR 30-59 (1); max 30.5; <7 not_increased, >=7 increased; half-points not integer-rounded; not Hostler 2016; not IMPROVE VTE",
  "max_score": 30.5,
  "score": 0.0,
  "age_years": 35,
  "sex": "female",
  "bleed_band": "not_increased",
  "renal_failure": "none"
}

Client errors (HTTP 400)

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

HTTP	Code	When
400	`invalid_improve_bleed`	IMPROVE bleeding inputs must match Decousus 2011 admission bleeding-risk factors and point weights from that paper. 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

IMPROVE VTE — Compute the Spyropoulos 2011 7-factor associative IMPROVE VTE score during hospitalization from age and six caller-assigned flags.
IMPROVEDD — Compute the Gibson 2017 IMPROVEDD VTE score from age, six caller-assigned IMPROVE flags, and caller-assigned D-dimer >=2x ULN.
Padua score — Compute the Barbar 2010 Padua Prediction Score for VTE risk in hospitalized medical patients from age and ten caller-assigned findings.

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. 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.