# Revised Intensity Battle Score (RIBS) RIBS Status: LIVE Price: $0.005 USDC `GET /api/calc/ribs` HTML: https://magentlab.com/docs/ribs Markdown: https://magentlab.com/docs/ribs.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum Buchholz 2023 RIBS regression points from caller-assigned rib-level fracture count, chest tube, pulmonary contusions, COPD, and GCS <15, and return the integer score and the published score-12 ICU triage band. ## When to use When an agent already has caller-assigned Buchholz 2023 inputs after rib fractures and needs the published RIBS total and score-12 band, not a CT rib count, GCS exam, Chapman 2016 RibScore, Battle 2014 STUMBL, diagnosis, or surgical plan. ## When not to use - Not a medical device. Not a diagnosis, disposition, ICU-admission, or surgical plan. - Not Chapman 2016 RibScore (six radiographic flags, integer 0–6 at /api/calc/ribscore). RIBS is the Buchholz 2023 Revised Intensity Battle Score. - Not Battle 2014 STUMBL. Age is not a component; the paper found age was not predictive. - magent does not read a CT, count ribs, or compute GCS. Rib count is rib level, not individual fracture count. Chest tube, pulmonary contusions, and COPD are caller-assigned flags. ## Formula ``` RIBS = round(2.275*rib_count + 1.525*pulmonary_contusions + 2.83*copd + 4.08*chest_tube + 8.137*(gcs<15)); Buchholz 2023; rib level not fracture count; age is not a component; ICU triage cutoff 12; not Chapman 2016 RibScore; not Battle 2014 STUMBL ``` ## Citation [Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures](https://doi.org/10.1177/00031348221123087) Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young JS, Calland JF Am Surg. 2023;89(10):4668-4674 DOI: [10.1177/00031348221123087](https://doi.org/10.1177/00031348221123087) ## Worked example ### One rib, GCS 15, no flags Given: `chest_tube=false, copd=false, gcs=15, pulmonary_contusions=false, rib_count=1` 1. rib_count 1 × 2.275 = 2.275; chest_tube, pulmonary_contusions, and copd false → 0; GCS 15 → GCS <15 false → 0 2. score = round(2.275) = 2; ribs_band below_12 (published ICU triage cutoff is 12) ### Four ribs and COPD at the score-12 cutoff Given: `chest_tube=false, copd=true, gcs=15, pulmonary_contusions=false, rib_count=4` 1. rib_count 4 × 2.275 = 9.1; copd true → 2.83; other flags false; GCS 15 → 0 2. score = round(11.93) = 12; ribs_band at_or_above_12 ## Also searched as - Revised Intensity Battle Score - RIBS - Buchholz RIBS - revised Battle score - rib fracture triage score - intensity Battle score - Buchholz 2023 rib score ## Parameters - `rib_count` (integer, required): Caller-assigned number of fractured rib levels, integer 0–24. Buchholz 2023: 2.275 points per rib level, not per individual fracture (six fractures on three ribs is 3). magent does not read a CT or count ribs. - `chest_tube` (boolean, required): Chest tube placed, present, or anticipated as assigned by the caller (Buchholz 2023). true or false. true scores 4.08 before rounding. - `pulmonary_contusions` (boolean, required): Pulmonary contusions as assigned by the caller (Buchholz 2023). true or false. true scores 1.525 before rounding. magent does not read a CT. - `copd` (boolean, required): History of COPD as assigned by the caller (Buchholz 2023). true or false. true scores 2.83 before rounding. Age is not a component. - `gcs` (integer, required): Caller-assigned Glasgow Coma Scale total, integer 3–15. Buchholz 2023 scores 8.137 when GCS <15 and 0 when GCS is 15. magent does not compute eye, verbal, or motor. ## 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/ribs` 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": [ { "chest_tube": "false", "copd": "false", "gcs": "15", "pulmonary_contusions": "false", "rib_count": "1" }, { "chest_tube": "false", "copd": "false", "gcs": "15", "pulmonary_contusions": "false", "rib_count": "1" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/ribs Example 200: ```json { "count": 2, "path": "/api/calc/ribs", "items": [ { "components": [ { "value": 1, "factor": "rib_count", "points": 2.275, "present": true }, { "factor": "chest_tube", "points": 0.0, "present": false }, { "factor": "pulmonary_contusions", "points": 0.0, "present": false }, { "factor": "copd", "points": 0.0, "present": false }, { "value": 15, "factor": "gcs", "points": 0.0, "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": "Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young JS, Calland JF", "doi": "10.1177/00031348221123087", "id": "buchholz-2022", "pmid": "36120831", "source": "Am Surg. 2023;89(10):4668-4674", "title": "Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures" }, "formula": "ribs", "formula_expression": "RIBS = round(2.275*rib_count + 1.525*pulmonary_contusions + 2.83*copd + 4.08*chest_tube + 8.137*(gcs<15)); Buchholz 2023; rib level not fracture count; age is not a component; ICU triage cutoff 12; not Chapman 2016 RibScore; not Battle 2014 STUMBL", "score": 2, "mortality_percent": 2.8, "gcs": 15, "copd": false, "any_complication_percent": 7.5, "chest_tube": false, "gcs_lt_15": false, "icu_triage_cutoff": false, "pneumonia_or_vap_percent": 3.0, "pulmonary_contusions": false, "rib_count": 1, "ribs_band": "below_12", "unplanned_icu_or_intubation_percent": 4.7, "vent_or_tracheostomy_percent": 1.9 }, { "components": [ { "value": 1, "factor": "rib_count", "points": 2.275, "present": true }, { "factor": "chest_tube", "points": 0.0, "present": false }, { "factor": "pulmonary_contusions", "points": 0.0, "present": false }, { "factor": "copd", "points": 0.0, "present": false }, { "value": 15, "factor": "gcs", "points": 0.0, "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": "Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young JS, Calland JF", "doi": "10.1177/00031348221123087", "id": "buchholz-2022", "pmid": "36120831", "source": "Am Surg. 2023;89(10):4668-4674", "title": "Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures" }, "formula": "ribs", "formula_expression": "RIBS = round(2.275*rib_count + 1.525*pulmonary_contusions + 2.83*copd + 4.08*chest_tube + 8.137*(gcs<15)); Buchholz 2023; rib level not fracture count; age is not a component; ICU triage cutoff 12; not Chapman 2016 RibScore; not Battle 2014 STUMBL", "score": 2, "mortality_percent": 2.8, "gcs": 15, "copd": false, "any_complication_percent": 7.5, "chest_tube": false, "gcs_lt_15": false, "icu_triage_cutoff": false, "pneumonia_or_vap_percent": 3.0, "pulmonary_contusions": false, "rib_count": 1, "ribs_band": "below_12", "unplanned_icu_or_intubation_percent": 4.7, "vent_or_tracheostomy_percent": 1.9 } ] } ``` ## Response fields - `formula` (string): ribs - `formula_expression` (string): Exact expression used - `score` (integer): Buchholz 2023 RIBS, rounded nearest integer - `ribs_band` (string): below_12 or at_or_above_12. Published ICU triage cutoff is 12. A band, not an ICU order. - `icu_triage_cutoff` (boolean): true when score ≥12 (Buchholz 2023 recommended ICU triage cutoff) - `any_complication_percent` (number): Published any-complication percent from logit 0.1879*score − 2.8823 - `unplanned_icu_or_intubation_percent` (number): Published unplanned ICU-upgrade or intubation percent - `vent_or_tracheostomy_percent` (number): Published >7 ventilator-days or tracheostomy percent - `pneumonia_or_vap_percent` (number): Published pneumonia or VAP percent - `mortality_percent` (number): Published mortality percent - `rib_count` (integer): Caller rib-level count used - `chest_tube` (boolean): Caller chest-tube flag used - `pulmonary_contusions` (boolean): Caller pulmonary-contusion flag used - `copd` (boolean): Caller COPD flag used - `gcs` (integer): Caller GCS total used - `gcs_lt_15` (boolean): true when caller GCS is 3–14 - `components` (array): Per-predictor Buchholz 2023 points - `citation` (object): Buchholz 2023 Am Surg citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 1, "factor": "rib_count", "points": 2.275, "present": true }, { "factor": "chest_tube", "points": 0.0, "present": false }, { "factor": "pulmonary_contusions", "points": 0.0, "present": false }, { "factor": "copd", "points": 0.0, "present": false }, { "value": 15, "factor": "gcs", "points": 0.0, "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": "Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young JS, Calland JF", "doi": "10.1177/00031348221123087", "id": "buchholz-2022", "pmid": "36120831", "source": "Am Surg. 2023;89(10):4668-4674", "title": "Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures" }, "formula": "ribs", "formula_expression": "RIBS = round(2.275*rib_count + 1.525*pulmonary_contusions + 2.83*copd + 4.08*chest_tube + 8.137*(gcs<15)); Buchholz 2023; rib level not fracture count; age is not a component; ICU triage cutoff 12; not Chapman 2016 RibScore; not Battle 2014 STUMBL", "score": 2, "mortality_percent": 2.8, "gcs": 15, "copd": false, "any_complication_percent": 7.5, "chest_tube": false, "gcs_lt_15": false, "icu_triage_cutoff": false, "pneumonia_or_vap_percent": 3.0, "pulmonary_contusions": false, "rib_count": 1, "ribs_band": "below_12", "unplanned_icu_or_intubation_percent": 4.7, "vent_or_tracheostomy_percent": 1.9 } ``` ## Errors - HTTP 400 `invalid_rib_count`: rib_count must be an integer from 0 through 24 (Battle 2014 STUMBL Table 4). Returned before settlement; you are not charged. - HTTP 400 `invalid_gcs_total`: gcs must be an integer from 3 to 15. 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 - [RibScore](https://magentlab.com/docs/ribscore) — Sum the six Chapman 2016 RibScore radiographic flags and return the integer total 0-6. That paper associated the score linearly with pneumonia, respiratory failure, and tracheostomy. - [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. ## 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.