# Modified Early Warning Score (Subbe) MEWS Status: LIVE Price: $0.005 USDC `GET /api/calc/mews` HTML: https://magentlab.com/docs/mews Markdown: https://magentlab.com/docs/mews.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Subbe 2001 modified Early Warning Score from systolic BP, heart rate, respiratory rate, temperature, and caller-assigned AVPU. ## When to use When an agent needs the published Subbe 2001 MEWS total and must not substitute NEWS2 or treat the score as an ICU-admission order. ## When not to use - Not a medical device and not an ICU-admission, HDU, or monitoring order. magent does not examine the patient. - This is Subbe 2001 modified Early Warning Score (Table 1) only. It is not NEWS, NEWS2, or other later early-warning modifications. - AVPU is caller-assigned (alert, voice, pain, or unresponsive). magent does not compute GCS here. - Temperature is in °C as published. magent does not convert Fahrenheit. - score_ge_5 follows the paper's association of scores of 5 or more with increased risk of death, ICU, or HDU. It is not a NEWS2 band. ## Formula ``` MEWS = sbp_points + hr_points + rr_points + temp_points + avpu_points; Subbe 2001 Table 1; max 14 ``` ## Citation [Validation of a modified Early Warning Score in medical admissions](https://doi.org/10.1093/qjmed/94.10.521) Subbe CP, Kruger M, Rutherford P, Gemmel L QJM. 2001;94(10):521-526 DOI: [10.1093/qjmed/94.10.521](https://doi.org/10.1093/qjmed/94.10.521) ## Worked example ### Normal vitals, alert Given: `avpu=alert, heart_rate_bpm=80, respiratory_rate=12, systolic_mm_hg=120, temperature_c=37.0` 1. SBP 120 → 0; HR 80 → 0; RR 12 → 0; temperature 37.0 → 0; AVPU alert → 0 2. Score = 0 (max 14); score_ge_5 = false ### SBP 70 and HR 111 Given: `avpu=alert, heart_rate_bpm=111, respiratory_rate=12, systolic_mm_hg=70, temperature_c=37.0` 1. SBP 70 → 3; HR 111 → 2; RR 12 → 0; temperature 37.0 → 0; AVPU alert → 0 2. Score = 5 (max 14); score_ge_5 = true ## Also searched as - modified early warning score - MEWS - Subbe MEWS - early warning score - AVPU MEWS - modified EWS ## Parameters - `systolic_mm_hg` (integer, required): Systolic blood pressure in mm Hg (integer 0-300). Subbe 2001: ≤70 → 3, 71-80 → 2, 81-100 → 1, 101-199 → 0, ≥200 → 2. - `heart_rate_bpm` (integer, required): Heart rate in beats/min (integer 30-220). Subbe 2001: ≤40 → 2, 41-50 → 1, 51-100 → 0, 101-110 → 1, 111-129 → 2, ≥130 → 3. - `respiratory_rate` (integer, required): Respiratory rate in breaths/min (integer 0-80). Subbe 2001: <9 → 2, 9-14 → 0, 15-20 → 1, 21-29 → 2, ≥30 → 3. - `temperature_c` (number, required): Temperature in °C (30.0-45.0). Subbe 2001: <35 → 2, 35-38.4 → 0, ≥38.5 → 2. magent does not convert Fahrenheit. - `avpu` (string, required): Caller-assigned AVPU (alert, voice, pain, or unresponsive). Subbe 2001: alert → 0, voice → 1, pain → 2, unresponsive → 3. magent does not compute GCS here. ## 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/mews` 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": [ { "avpu": "alert", "heart_rate_bpm": "80", "respiratory_rate": "12", "systolic_mm_hg": "120", "temperature_c": "37.0" }, { "avpu": "alert", "heart_rate_bpm": "80", "respiratory_rate": "12", "systolic_mm_hg": "120", "temperature_c": "37.0" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/mews Example 200: ```json { "count": 2, "path": "/api/calc/mews", "items": [ { "components": [ { "value": 120, "factor": "systolic_mm_hg", "points": 0, "present": false }, { "value": 80, "factor": "heart_rate_bpm", "points": 0, "present": false }, { "value": 12, "factor": "respiratory_rate", "points": 0, "present": false }, { "value": 37.0, "factor": "temperature_c", "points": 0, "present": false }, { "value": "alert", "factor": "avpu", "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": "Subbe CP, Kruger M, Rutherford P, Gemmel L", "doi": "10.1093/qjmed/94.10.521", "id": "subbe-2001", "pmid": "11588210", "source": "QJM. 2001;94(10):521-526", "title": "Validation of a modified Early Warning Score in medical admissions" }, "formula": "mews", "formula_expression": "MEWS = sbp_points + hr_points + rr_points + temp_points + avpu_points; Subbe 2001 Table 1; max 14", "max_score": 14, "score": 0, "systolic_mm_hg": 120, "temperature_c": 37.0, "heart_rate_bpm": 80, "avpu": "alert", "respiratory_rate": 12, "score_ge_5": false }, { "components": [ { "value": 120, "factor": "systolic_mm_hg", "points": 0, "present": false }, { "value": 80, "factor": "heart_rate_bpm", "points": 0, "present": false }, { "value": 12, "factor": "respiratory_rate", "points": 0, "present": false }, { "value": 37.0, "factor": "temperature_c", "points": 0, "present": false }, { "value": "alert", "factor": "avpu", "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": "Subbe CP, Kruger M, Rutherford P, Gemmel L", "doi": "10.1093/qjmed/94.10.521", "id": "subbe-2001", "pmid": "11588210", "source": "QJM. 2001;94(10):521-526", "title": "Validation of a modified Early Warning Score in medical admissions" }, "formula": "mews", "formula_expression": "MEWS = sbp_points + hr_points + rr_points + temp_points + avpu_points; Subbe 2001 Table 1; max 14", "max_score": 14, "score": 0, "systolic_mm_hg": 120, "temperature_c": 37.0, "heart_rate_bpm": 80, "avpu": "alert", "respiratory_rate": 12, "score_ge_5": false } ] } ``` ## Response fields - `formula` (string): mews - `formula_expression` (string): Exact expression used - `score` (integer): MEWS points 0-14 - `max_score` (integer): Always 14 - `score_ge_5` (boolean): true when score is ≥5. Subbe 2001 associated scores of 5 or more with increased risk of death, ICU, or HDU. Not an ICU-admission order. - `systolic_mm_hg` (integer): Systolic BP used, mm Hg - `heart_rate_bpm` (integer): Heart rate used, bpm - `respiratory_rate` (integer): Respiratory rate used, breaths/min - `temperature_c` (number): Temperature used, °C - `avpu` (string): Caller-assigned AVPU used - `components` (array): Per-vital points - `citation` (object): Subbe 2001 QJM citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 120, "factor": "systolic_mm_hg", "points": 0, "present": false }, { "value": 80, "factor": "heart_rate_bpm", "points": 0, "present": false }, { "value": 12, "factor": "respiratory_rate", "points": 0, "present": false }, { "value": 37.0, "factor": "temperature_c", "points": 0, "present": false }, { "value": "alert", "factor": "avpu", "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": "Subbe CP, Kruger M, Rutherford P, Gemmel L", "doi": "10.1093/qjmed/94.10.521", "id": "subbe-2001", "pmid": "11588210", "source": "QJM. 2001;94(10):521-526", "title": "Validation of a modified Early Warning Score in medical admissions" }, "formula": "mews", "formula_expression": "MEWS = sbp_points + hr_points + rr_points + temp_points + avpu_points; Subbe 2001 Table 1; max 14", "max_score": 14, "score": 0, "systolic_mm_hg": 120, "temperature_c": 37.0, "heart_rate_bpm": 80, "avpu": "alert", "respiratory_rate": 12, "score_ge_5": false } ``` ## Errors - HTTP 400 `invalid_rts_systolic`: systolic_mm_hg must be an integer from 0 to 300. Returned before settlement; you are not charged. - HTTP 400 `invalid_heart_rate`: heart_rate_bpm must be an integer from 30 to 220 Returned before settlement; you are not charged. - HTTP 400 `invalid_rts_respiratory_rate`: respiratory_rate must be an integer from 0 to 80. Returned before settlement; you are not charged. - HTTP 400 `invalid_temperature`: temperature_c must be a number from 30.0 to 45.0. Returned before settlement; you are not charged. - HTTP 400 `invalid_mews_avpu`: avpu must be alert, voice, pain, or unresponsive (Subbe 2001). 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 - [qSOFA](https://magentlab.com/docs/qsofa) — Compute the Sepsis-3 qSOFA score from respiratory rate, caller-assigned altered mentation, and systolic blood pressure. - [SIRS](https://magentlab.com/docs/sirs) — Compute the Bone 1992 ACCP/SCCM SIRS criteria from temperature, heart rate, respiratory rate, and WBC, with optional PaCO2 and band percent. - [SOFA](https://magentlab.com/docs/sofa) — Compute the Vincent 1996 SOFA score from PaO2/FiO2, platelets, bilirubin, MAP and adrenergic agents, GCS, and creatinine or urine output. ## 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 echoing accepted, payload, and extensions when present). - 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. - 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.