Neurology · LIVE

PASCAL classification

PASCAL

Apply the Kent 2021 PASCAL classification (Table 1) from a caller-assigned RoPE total and large-shunt plus atrial-septal-aneurysm flags, and return probable, possible, or unlikely PFO-related stroke likelihood.

LIVE $0.005 USDC GET /api/calc/pascal

Markdown: /docs/pascal.md · Canonical: https://magentlab.com/docs/pascal

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

What it computes

Apply the Kent 2021 PASCAL classification (Table 1) from a caller-assigned RoPE total and large-shunt plus atrial-septal-aneurysm flags, and return probable, possible, or unlikely PFO-related stroke likelihood.

When to use

When an agent already has a caller-assigned RoPE total (0-10) and caller-assigned large-shunt and ASA flags after cryptogenic stroke with PFO, and must not invent a closure order, recompute RoPE, or apply ESUS.

When not to use

• Not a medical device. Not a PFO diagnosis and not a closure or device-indication order.
• rope_score is the caller-assigned Kent 2013 RoPE total (0-10). magent does not recompute RoPE; use the related rope tool for that index.
• large_shunt and atrial_septal_aneurysm are caller-assigned. magent does not read echocardiography and does not echo those flags.
• This is Kent 2021 PASCAL, not RoPE itself and not the Hart 2014 ESUS construct.
• Pooled-trial ages were 18-60 years. That eligibility is a limitation, not an HTTP 400; RoPE already encodes age.

Formula

high_rope iff rope_score >= 7; high_risk_pfo iff large_shunt or atrial_septal_aneurysm; probable iff both; possible iff exactly one; unlikely iff neither (Kent 2021 Table 1 PASCAL). magent does not recompute RoPE

Citation

Title

Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke

Authors

Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE

Source

JAMA. 2021;326(22):2277-2286

DOI

10.1001/jama.2021.20956

Worked example

Also searched as

• PASCAL classification
• PFO-Associated Stroke Causal Likelihood
• Kent PASCAL
• high-risk PFO
• RoPE score PASCAL
• patent foramen ovale causal likelihood
• Kent 2021 PASCAL
• large shunt ASA PFO
• PFO-related stroke likelihood

Try

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

/api/calc/pascal?rope_score=8&large_shunt=true&atrial_septal_aneurysm=false

Full URL: https://api.magentlab.com/api/calc/pascal?rope_score=8&large_shunt=true&atrial_septal_aneurysm=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/pascal?rope_score=8&large_shunt=true&atrial_septal_aneurysm=false"

Parameters

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/pascal 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": [
    {
      "atrial_septal_aneurysm": "false",
      "large_shunt": "true",
      "rope_score": "8"
    },
    {
      "atrial_septal_aneurysm": "false",
      "large_shunt": "true",
      "rope_score": "8"
    }
  ]
}

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/pascal",
  "items": [
    {
      "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": "Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE",
        "doi": "10.1001/jama.2021.20956",
        "id": "kent-2021",
        "pmid": "34905030",
        "source": "JAMA. 2021;326(22):2277-2286",
        "title": "Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke"
      },
      "formula": "pascal",
      "formula_expression": "high_rope iff rope_score >= 7; high_risk_pfo iff large_shunt or atrial_septal_aneurysm; probable iff both; possible iff exactly one; unlikely iff neither (Kent 2021 Table 1 PASCAL). magent does not recompute RoPE",
      "criteria": [
        {
          "value": 8,
          "factor": "high_rope",
          "met": true
        },
        {
          "factor": "high_risk_pfo",
          "met": true
        }
      ],
      "high_risk_pfo": true,
      "high_rope": true,
      "pascal_class": "probable",
      "rope_score": 8
    },
    {
      "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": "Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE",
        "doi": "10.1001/jama.2021.20956",
        "id": "kent-2021",
        "pmid": "34905030",
        "source": "JAMA. 2021;326(22):2277-2286",
        "title": "Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke"
      },
      "formula": "pascal",
      "formula_expression": "high_rope iff rope_score >= 7; high_risk_pfo iff large_shunt or atrial_septal_aneurysm; probable iff both; possible iff exactly one; unlikely iff neither (Kent 2021 Table 1 PASCAL). magent does not recompute RoPE",
      "criteria": [
        {
          "value": 8,
          "factor": "high_rope",
          "met": true
        },
        {
          "factor": "high_risk_pfo",
          "met": true
        }
      ],
      "high_risk_pfo": true,
      "high_rope": true,
      "pascal_class": "probable",
      "rope_score": 8
    }
  ]
}

Response

Example JSON

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

{
  "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": "Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE",
    "doi": "10.1001/jama.2021.20956",
    "id": "kent-2021",
    "pmid": "34905030",
    "source": "JAMA. 2021;326(22):2277-2286",
    "title": "Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke"
  },
  "formula": "pascal",
  "formula_expression": "high_rope iff rope_score >= 7; high_risk_pfo iff large_shunt or atrial_septal_aneurysm; probable iff both; possible iff exactly one; unlikely iff neither (Kent 2021 Table 1 PASCAL). magent does not recompute RoPE",
  "criteria": [
    {
      "value": 8,
      "factor": "high_rope",
      "met": true
    },
    {
      "factor": "high_risk_pfo",
      "met": true
    }
  ],
  "high_risk_pfo": true,
  "high_rope": true,
  "pascal_class": "probable",
  "rope_score": 8
}

Client errors (HTTP 400)

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

Related tools

• ROPE — Compute the Kent 2013 Risk of Paradoxical Embolism (ROPE) index from Table 4 age decades and five caller-assigned vascular and infarct flags.
• ESUS — Apply the Hart 2014 ESUS construct (Panel 2 criteria plus Panel 3 minimum diagnostic assessment) and return whether caller-assigned flags meet embolic stroke of undetermined source.
• ABCD2 score — Compute the ABCD2 score as age, blood pressure, caller-assigned clinical features, symptom duration, and diabetes.

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.