# Modified Rankin scale

Modified Rankin

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

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

## What it computes

Return the van Swieten 1988 modified Rankin handicap grade 0-5 from a caller-assigned integer, with the published grade wording.

## When to use

When an agent needs the 1988 modified Rankin handicap grade 0-5 and must not invent grade 6 (dead), Rankin 1957 five-grade wording, or a discharge or disability-benefit protocol.

## When not to use

- Not a medical device and not a diagnosis. Not a discharge or disability-benefit protocol. magent does not interview the patient.
- van Swieten 1988 is grades 0-5 only and does not include a dead grade. Grade 6 (dead) is a later addition and is not returned.
- The caller assigns mrs 0-5. magent does not examine the patient or apply a structured interview.

## Formula

```
modified Rankin 0-5 as assigned by the caller; van Swieten 1988 six grades (no dead grade)
```

## Citation

[Interobserver agreement for the assessment of handicap in stroke patients](https://doi.org/10.1161/01.STR.19.5.604)
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J
Stroke. 1988;19(5):604-607
DOI: [10.1161/01.STR.19.5.604](https://doi.org/10.1161/01.STR.19.5.604)

## Worked example

### Grade 0 no symptoms

Given: `mrs=0`

1. mrs 0 → no symptoms at all; score 0; max 5


## Also searched as

- mRS
- modified Rankin scale
- modified Rankin score
- Rankin handicap grade
- van Swieten Rankin
- stroke disability grade
- mRS 0-5

## Parameters

- `mrs` (integer, required): van Swieten 1988 modified Rankin handicap grade 0-5 as assigned by the caller (0 no symptoms at all; 1 no significant disability despite symptoms; 2 slight disability; 3 moderate disability, walks unaided; 4 moderately severe, unable to walk unaided; 5 severe, bedridden, incontinent, constant nursing). magent does not interview the patient.

## 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/modified_rankin`
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": [
    {
      "mrs": "0"
    },
    {
      "mrs": "0"
    }
  ]
}
```

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

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/modified_rankin",
  "items": [
    {
      "components": [
        {
          "factor": "mrs",
          "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": "van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J",
        "doi": "10.1161/01.STR.19.5.604",
        "id": "van-swieten-1988",
        "pmid": "3363593",
        "source": "Stroke. 1988;19(5):604-607",
        "title": "Interobserver agreement for the assessment of handicap in stroke patients"
      },
      "formula": "modified_rankin",
      "formula_expression": "modified Rankin 0-5 as assigned by the caller; van Swieten 1988 six grades (no dead grade)",
      "max_score": 5,
      "score": 0,
      "grade": "No symptoms at all",
      "mrs": 0
    },
    {
      "components": [
        {
          "factor": "mrs",
          "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": "van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J",
        "doi": "10.1161/01.STR.19.5.604",
        "id": "van-swieten-1988",
        "pmid": "3363593",
        "source": "Stroke. 1988;19(5):604-607",
        "title": "Interobserver agreement for the assessment of handicap in stroke patients"
      },
      "formula": "modified_rankin",
      "formula_expression": "modified Rankin 0-5 as assigned by the caller; van Swieten 1988 six grades (no dead grade)",
      "max_score": 5,
      "score": 0,
      "grade": "No symptoms at all",
      "mrs": 0
    }
  ]
}
```

## Response fields

- `formula` (string): modified_rankin
- `formula_expression` (string): Published grade rule
- `mrs` (integer): Caller-assigned modified Rankin grade 0-5
- `score` (integer): Same as mrs
- `max_score` (integer): 5
- `grade` (string): van Swieten 1988 wording for that grade
- `components` (array): mrs component
- `citation` (object): van Swieten 1988
- `disclaimer` (string): Not a medical device

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "mrs",
      "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": "van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J",
    "doi": "10.1161/01.STR.19.5.604",
    "id": "van-swieten-1988",
    "pmid": "3363593",
    "source": "Stroke. 1988;19(5):604-607",
    "title": "Interobserver agreement for the assessment of handicap in stroke patients"
  },
  "formula": "modified_rankin",
  "formula_expression": "modified Rankin 0-5 as assigned by the caller; van Swieten 1988 six grades (no dead grade)",
  "max_score": 5,
  "score": 0,
  "grade": "No symptoms at all",
  "mrs": 0
}
```

## Errors

- HTTP 400 `invalid_mrs`: mrs must be an integer from 0 to 5 (van Swieten 1988 grades). 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

- [Glasgow Coma Scale](https://magentlab.com/docs/gcs) — Compute the Glasgow Coma Scale as the sum of caller-assigned eye, verbal, and motor integers. The 1974 or 1976 edition is required.
- [ABCD2 score](https://magentlab.com/docs/abcd2) — Compute the ABCD2 score as age, blood pressure, caller-assigned clinical features, symptom duration, and diabetes.
- [FUNC score](https://magentlab.com/docs/func-score) — Compute the Rost 2008 FUNC score from caller-assigned ICH volume, age, location, GCS, and pre-ICH cognitive impairment.

## 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.