# Pediatric BIG score

Pediatric BIG score

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/pediatric_big`
HTML: https://magentlab.com/docs/pediatric-big
Markdown: https://magentlab.com/docs/pediatric-big.md

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

## What it computes

Compute the Borgman 2011 pediatric trauma BIG score from caller-assigned admission base deficit in mmol/L, INR, and GCS. Returns the published arithmetic only.

## When to use

When an agent already has admission base deficit, INR, and a 3-15 GCS and needs the Borgman 2011 BIG score, not PTS, not ISS, and not a later mortality cutoff.

## When not to use

- Not a medical device and not a trauma-bay disposition order.
- magent does not assay blood gas or INR or compute GCS. base_deficit, inr, and gcs are caller-assigned. Base deficit is used as Borgman 2011 prints it (mmol/L); magent does not flip a signed base-excess value.
- Borgman 2011 publishes the equation BIG = admission base deficit + (2.5 × INR) + (15 − GCS). It does not print a ≥12.7 or ≥16 mortality cut. magent returns the numeric score only.

## Formula

```
BIG = base_deficit + (2.5 * inr) + (15 - gcs); Borgman 2011; admission base deficit mmol/L as published (not a signed base-excess flip); INR unitless; GCS integer 3-15; magent does not assay blood gas or INR or compute GCS; no later 12.7 or 16 mortality cut
```

## Citation

[Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma](https://doi.org/10.1542/peds.2010-2439)
Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC
Pediatrics. 2011;127(4):e892-e897
DOI: [10.1542/peds.2010-2439](https://doi.org/10.1542/peds.2010-2439)

## Worked example

### BD 0, INR 1.0, GCS 15

Given: `base_deficit=0, gcs=15, inr=1.0`

1. BIG = 0 + (2.5 * 1.0) + (15 - 15) = 2.5


### BD 8, INR 1.8, GCS 8

Given: `base_deficit=8, gcs=8, inr=1.8`

1. BIG = 8 + (2.5 * 1.8) + (15 - 8) = 8 + 4.5 + 7 = 19.5


## Also searched as

- BIG score
- pediatric BIG score
- pediatric trauma BIG
- Borgman BIG score
- base deficit INR GCS
- pediatric trauma mortality BIG
- BD INR GCS score

## Parameters

- `base_deficit` (number, required): Admission base deficit in mmol/L as Borgman 2011 uses it (−20 to 30 magent clamp). A larger positive deficit raises the score. magent does not assay blood gas and does not negate a signed base-excess value.
- `inr` (number, required): Caller-assigned international normalized ratio (0.8-10.0 magent clamp). magent does not assay INR.
- `gcs` (integer, required): Caller-assigned Glasgow Coma Scale total, integer 3-15 (published range). magent does not compute eye, verbal, or motor GCS.

## 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/pediatric_big`
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": [
    {
      "base_deficit": "0",
      "gcs": "15",
      "inr": "1.0"
    },
    {
      "base_deficit": "0",
      "gcs": "15",
      "inr": "1.0"
    }
  ]
}
```

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

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/pediatric_big",
  "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": "Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC",
        "doi": "10.1542/peds.2010-2439",
        "id": "borgman-2011",
        "pmid": "21422095",
        "source": "Pediatrics. 2011;127(4):e892-e897",
        "title": "Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma"
      },
      "formula": "pediatric_big",
      "formula_expression": "BIG = base_deficit + (2.5 * inr) + (15 - gcs); Borgman 2011; admission base deficit mmol/L as published (not a signed base-excess flip); INR unitless; GCS integer 3-15; magent does not assay blood gas or INR or compute GCS; no later 12.7 or 16 mortality cut",
      "score": 2.5,
      "inr": 1.0,
      "gcs": 15,
      "base_deficit": 0.0
    },
    {
      "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": "Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC",
        "doi": "10.1542/peds.2010-2439",
        "id": "borgman-2011",
        "pmid": "21422095",
        "source": "Pediatrics. 2011;127(4):e892-e897",
        "title": "Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma"
      },
      "formula": "pediatric_big",
      "formula_expression": "BIG = base_deficit + (2.5 * inr) + (15 - gcs); Borgman 2011; admission base deficit mmol/L as published (not a signed base-excess flip); INR unitless; GCS integer 3-15; magent does not assay blood gas or INR or compute GCS; no later 12.7 or 16 mortality cut",
      "score": 2.5,
      "inr": 1.0,
      "gcs": 15,
      "base_deficit": 0.0
    }
  ]
}
```

## Response fields

- `formula` (string): pediatric_big
- `formula_expression` (string): Exact expression used
- `base_deficit` (number): Admission base deficit in mmol/L used (Borgman 2011 sign, not flipped BE)
- `inr` (number): INR used
- `gcs` (integer): GCS total used (3-15)
- `score` (number): Borgman 2011 BIG score, 1 decimal. Numeric score only; no later 12.7 or 16 mortality cut.
- `citation` (object): Borgman 2011 Pediatrics citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "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": "Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC",
    "doi": "10.1542/peds.2010-2439",
    "id": "borgman-2011",
    "pmid": "21422095",
    "source": "Pediatrics. 2011;127(4):e892-e897",
    "title": "Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma"
  },
  "formula": "pediatric_big",
  "formula_expression": "BIG = base_deficit + (2.5 * inr) + (15 - gcs); Borgman 2011; admission base deficit mmol/L as published (not a signed base-excess flip); INR unitless; GCS integer 3-15; magent does not assay blood gas or INR or compute GCS; no later 12.7 or 16 mortality cut",
  "score": 2.5,
  "inr": 1.0,
  "gcs": 15,
  "base_deficit": 0.0
}
```

## Errors

- HTTP 400 `invalid_pediatric_big`: Pediatric BIG score inputs must be numeric base deficit, INR, and GCS in the Borgman 2011 published ranges. 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

- [PTS](https://magentlab.com/docs/pts) — Compute the Tepas 1987 Pediatric Trauma Score from caller-assigned weight, airway, systolic BP, CNS, skeletal, and wound grades.
- [ISS](https://magentlab.com/docs/iss) — Compute the Baker 1974 Injury Severity Score as the sum of squares of the three highest caller-assigned AIS body-region grades, or 75 if any region is AIS 6.
- [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.

## 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.