# IMPROVEDD VTE risk score IMPROVEDD Status: LIVE Price: $0.005 USDC `GET /api/calc/improvedd` HTML: https://magentlab.com/docs/improvedd Markdown: https://magentlab.com/docs/improvedd.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Gibson 2017 IMPROVEDD VTE score from age, six caller-assigned IMPROVE flags, and caller-assigned D-dimer >=2x ULN. ## When to use When an agent needs the published IMPROVEDD VTE score (Spyropoulos 2011 7-factor associative IMPROVE items plus D-dimer >=2x ULN). Not the 4-factor admission predictive model, not Padua, not Caprini. magent does not assay D-dimer, does not examine the patient, and does not diagnose VTE or issue a prophylaxis order. ## When not to use - Not a medical device. - Not a VTE diagnosis. magent does not diagnose venous thromboembolism. - Not a prophylaxis order. This tool does not recommend a drug or start thromboprophylaxis. - Gibson 2017 IMPROVEDD: Spyropoulos 2011 7-factor associative IMPROVE items plus 2 points if caller-assigned D-dimer is >=2x ULN. Max 14. Cutoff 0-1 (low) vs >=2 (high; heightened VTE risk through 77 days). Does not copy Spyropoulos 2011 observed hospitalization percents. - Not the 4-factor admission-only predictive IMPROVE model. - Not Padua or Caprini. - magent does not assay D-dimer. d_dimer_ge_2x_uln is caller-assigned. - magent does not examine the patient. Flags are caller-assigned. ## Formula ``` IMPROVEDD VTE (Gibson 2017; Spyropoulos 2011 7-factor associative items plus D-dimer >=2x ULN) = previous_vte (3) + known_thrombophilia (2) + lower_limb_paralysis (2) + current_cancer (2) + immobilized_ge_7_days (1) + icu_ccu_stay (1) + age>60 (1) + d_dimer_ge_2x_uln (2); max 14; 0-1 low vs >=2 high (heightened VTE risk through 77 days when >=2); not the 4-factor admission predictive model; not Padua; not Caprini ``` ## Citation [The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification](https://doi.org/10.1055/s-0037-1603929) Gibson CM, Spyropoulos AC, Cohen AT, Hull RD, Goldhaber SZ, Yusen RD, Hernandez AF, Korjian S, Daaboul Y, Gold A, Harrington RA, Chi G TH Open. 2017;1(1):e56-e65 DOI: [10.1055/s-0037-1603929](https://doi.org/10.1055/s-0037-1603929) ## Worked example ### Age 50, all flags false including D-dimer Given: `age=50, current_cancer=false, d_dimer_ge_2x_uln=false, icu_ccu_stay=false, immobilized_ge_7_days=false, known_thrombophilia=false, lower_limb_paralysis=false, previous_vte=false` 1. Age 50 is not >60 → 0; all seven flags false → 0 2. Score = 0 (max 14); vte_band low (0-1) ### D-dimer >=2x ULN alone is high Given: `age=50, current_cancer=false, d_dimer_ge_2x_uln=true, icu_ccu_stay=false, immobilized_ge_7_days=false, known_thrombophilia=false, lower_limb_paralysis=false, previous_vte=false` 1. d_dimer_ge_2x_uln → 2; age 50 not >60 → 0 2. Score = 2 (max 14); vte_band high (>=2) ## Also searched as - IMPROVEDD VTE score - IMPROVEDD - Gibson IMPROVEDD - IMPROVE D-dimer VTE - D-dimer IMPROVE score - hospital VTE D-dimer - IMPROVEDD risk score ## Parameters - `age` (integer, required): Age in years (18-120). Scores 1 when age >60 (Spyropoulos 2011 / Gibson 2017). Age 60 scores 0; age 61 scores 1. - `previous_vte` (boolean, required): Previous VTE as assigned by the caller (Spyropoulos 2011 7-factor associative items in Gibson 2017 IMPROVEDD). true or false. 3 points if true. magent does not diagnose VTE. - `known_thrombophilia` (boolean, required): Known thrombophilia as assigned by the caller (Spyropoulos 2011 / Gibson 2017). true or false. 2 points if true. magent does not interpret a thrombophilia panel. - `lower_limb_paralysis` (boolean, required): Lower-limb paralysis as assigned by the caller (Spyropoulos 2011 / Gibson 2017). true or false. 2 points if true. magent does not examine the patient. - `current_cancer` (boolean, required): Current cancer as assigned by the caller (Spyropoulos 2011 / Gibson 2017). true or false. 2 points if true. magent does not diagnose cancer. - `immobilized_ge_7_days` (boolean, required): Immobilized >=7 days as assigned by the caller (Spyropoulos 2011 / Gibson 2017, during hospitalization). true or false. 1 point if true. magent does not observe mobility. - `icu_ccu_stay` (boolean, required): ICU or CCU stay as assigned by the caller (Spyropoulos 2011 / Gibson 2017, during hospitalization). true or false. 1 point if true. magent does not assign level of care. - `d_dimer_ge_2x_uln` (boolean, required): D-dimer >=2x the local upper limit of normal as assigned by the caller (Gibson 2017). true or false. 2 points if true. magent does not assay D-dimer. ## 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/improvedd` 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": [ { "age": "50", "current_cancer": "false", "d_dimer_ge_2x_uln": "false", "icu_ccu_stay": "false", "immobilized_ge_7_days": "false", "known_thrombophilia": "false", "lower_limb_paralysis": "false", "previous_vte": "false" }, { "age": "50", "current_cancer": "false", "d_dimer_ge_2x_uln": "false", "icu_ccu_stay": "false", "immobilized_ge_7_days": "false", "known_thrombophilia": "false", "lower_limb_paralysis": "false", "previous_vte": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/improvedd Example 200: ```json { "count": 2, "path": "/api/calc/improvedd", "items": [ { "components": [ { "factor": "previous_vte", "points": 0, "present": false }, { "factor": "known_thrombophilia", "points": 0, "present": false }, { "factor": "lower_limb_paralysis", "points": 0, "present": false }, { "factor": "current_cancer", "points": 0, "present": false }, { "factor": "immobilized_ge_7_days", "points": 0, "present": false }, { "factor": "icu_ccu_stay", "points": 0, "present": false }, { "value": 50, "factor": "age_gt_60", "points": 0, "present": false }, { "factor": "d_dimer_ge_2x_uln", "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": "Gibson CM, Spyropoulos AC, Cohen AT, Hull RD, Goldhaber SZ, Yusen RD, Hernandez AF, Korjian S, Daaboul Y, Gold A, Harrington RA, Chi G", "doi": "10.1055/s-0037-1603929", "id": "gibson-2017", "pmid": "31249911", "source": "TH Open. 2017;1(1):e56-e65", "title": "The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification" }, "formula": "improvedd", "formula_expression": "IMPROVEDD VTE (Gibson 2017; Spyropoulos 2011 7-factor associative items plus D-dimer >=2x ULN) = previous_vte (3) + known_thrombophilia (2) + lower_limb_paralysis (2) + current_cancer (2) + immobilized_ge_7_days (1) + icu_ccu_stay (1) + age>60 (1) + d_dimer_ge_2x_uln (2); max 14; 0-1 low vs >=2 high (heightened VTE risk through 77 days when >=2); not the 4-factor admission predictive model; not Padua; not Caprini", "age_years": 50, "max_score": 14, "score": 0, "vte_band": "low" }, { "components": [ { "factor": "previous_vte", "points": 0, "present": false }, { "factor": "known_thrombophilia", "points": 0, "present": false }, { "factor": "lower_limb_paralysis", "points": 0, "present": false }, { "factor": "current_cancer", "points": 0, "present": false }, { "factor": "immobilized_ge_7_days", "points": 0, "present": false }, { "factor": "icu_ccu_stay", "points": 0, "present": false }, { "value": 50, "factor": "age_gt_60", "points": 0, "present": false }, { "factor": "d_dimer_ge_2x_uln", "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": "Gibson CM, Spyropoulos AC, Cohen AT, Hull RD, Goldhaber SZ, Yusen RD, Hernandez AF, Korjian S, Daaboul Y, Gold A, Harrington RA, Chi G", "doi": "10.1055/s-0037-1603929", "id": "gibson-2017", "pmid": "31249911", "source": "TH Open. 2017;1(1):e56-e65", "title": "The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification" }, "formula": "improvedd", "formula_expression": "IMPROVEDD VTE (Gibson 2017; Spyropoulos 2011 7-factor associative items plus D-dimer >=2x ULN) = previous_vte (3) + known_thrombophilia (2) + lower_limb_paralysis (2) + current_cancer (2) + immobilized_ge_7_days (1) + icu_ccu_stay (1) + age>60 (1) + d_dimer_ge_2x_uln (2); max 14; 0-1 low vs >=2 high (heightened VTE risk through 77 days when >=2); not the 4-factor admission predictive model; not Padua; not Caprini", "age_years": 50, "max_score": 14, "score": 0, "vte_band": "low" } ] } ``` ## Response fields - `formula` (string): improvedd - `formula_expression` (string): Exact expression used - `score` (integer): Total points 0-14 - `max_score` (integer): Always 14 - `vte_band` (string): Gibson 2017 cutoff: low (score 0-1) vs high (score >=2, heightened VTE risk through 77 days). Not a diagnosis and not a prophylaxis order. - `age_years` (integer): Age used for the >60 criterion - `components` (array): Per-item points - `citation` (object): Gibson 2017 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "previous_vte", "points": 0, "present": false }, { "factor": "known_thrombophilia", "points": 0, "present": false }, { "factor": "lower_limb_paralysis", "points": 0, "present": false }, { "factor": "current_cancer", "points": 0, "present": false }, { "factor": "immobilized_ge_7_days", "points": 0, "present": false }, { "factor": "icu_ccu_stay", "points": 0, "present": false }, { "value": 50, "factor": "age_gt_60", "points": 0, "present": false }, { "factor": "d_dimer_ge_2x_uln", "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": "Gibson CM, Spyropoulos AC, Cohen AT, Hull RD, Goldhaber SZ, Yusen RD, Hernandez AF, Korjian S, Daaboul Y, Gold A, Harrington RA, Chi G", "doi": "10.1055/s-0037-1603929", "id": "gibson-2017", "pmid": "31249911", "source": "TH Open. 2017;1(1):e56-e65", "title": "The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification" }, "formula": "improvedd", "formula_expression": "IMPROVEDD VTE (Gibson 2017; Spyropoulos 2011 7-factor associative items plus D-dimer >=2x ULN) = previous_vte (3) + known_thrombophilia (2) + lower_limb_paralysis (2) + current_cancer (2) + immobilized_ge_7_days (1) + icu_ccu_stay (1) + age>60 (1) + d_dimer_ge_2x_uln (2); max 14; 0-1 low vs >=2 high (heightened VTE risk through 77 days when >=2); not the 4-factor admission predictive model; not Padua; not Caprini", "age_years": 50, "max_score": 14, "score": 0, "vte_band": "low" } ``` ## Errors - HTTP 400 `invalid_age`: age must be an integer from 18 to 120 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 - [IMPROVE VTE](https://magentlab.com/docs/improve-vte) — Compute the Spyropoulos 2011 7-factor associative IMPROVE VTE score during hospitalization from age and six caller-assigned flags. ## 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.