# ROSE syncope rule ROSE Status: LIVE Price: $0.005 USDC `GET /api/calc/rose` HTML: https://magentlab.com/docs/rose Markdown: https://magentlab.com/docs/rose.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Reed 2010 ROSE (BRACES) criterion count and high-risk flag from published cutoffs. ## When to use When an agent needs the published ROSE BRACES arithmetic and must not invent a disposition from a syncope narrative. ## When not to use - Not a medical device. Not a disposition protocol, admission order, or discharge decision. - High-risk means any BRACES criterion (score ≥ 1), not a diagnosis. - magent does not measure BNP, hemoglobin, or SpO2, and does not read an ECG. The caller assigns fecal occult blood, chest pain, and the Q-wave-not-lead-III flag. ## Formula ``` ROSE = bnp_ge_300 + heart_rate_le_50 + fecal_occult_blood + hemoglobin_le_90 + chest_pain + q_wave_not_lead_iii + spo2_le_94; each 1 if present; rose_high_risk iff score >= 1; max 7 (Reed 2010 BRACES) ``` ## Citation [The ROSE (Risk Stratification of Syncope in the Emergency Department) Study](https://doi.org/10.1016/j.jacc.2009.09.049) Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ J Am Coll Cardiol. 2010;55(8):713-721 DOI: [10.1016/j.jacc.2009.09.049](https://doi.org/10.1016/j.jacc.2009.09.049) ## Worked example ### All BRACES criteria negative Given: `bnp_pg_ml=50, chest_pain=false, fecal_occult_blood=false, heart_rate_bpm=70, hemoglobin_g_l=130, q_wave_not_lead_iii=false, spo2_percent=98` 1. BNP 50 (<300); heart rate 70 (>50); FOB false; hemoglobin 130 g/L (>90); no chest pain; Q wave not assigned; SpO2 98% (>94) 2. Score = 0; rose_high_risk false ## Also searched as - ROSE syncope - Reed ROSE score - BRACES syncope - Risk Stratification of Syncope in the Emergency Department - ROSE ED syncope - BNP syncope rule ## Parameters - `bnp_pg_ml` (number, required): BNP in pg/mL (0-35000). Reed 2010 BRACES scores 1 when ≥300; 300 is high-risk. magent does not measure BNP. - `heart_rate_bpm` (integer, required): Heart rate in beats/min (integer 30-220). Reed 2010 bradycardia ≤50 (ED or pre-hospital in the paper; this tool takes one integer). 50 scores 1. magent does not measure heart rate. - `fecal_occult_blood` (boolean, required): Rectal exam showing fecal occult blood if GI-bleed suspicion (Reed 2010 R). true or false as assigned by the caller. - `hemoglobin_g_l` (number, required): Hemoglobin in g/L (30-220). Reed 2010 anemia scores 1 when ≤90; 90 is high-risk. magent does not assay hemoglobin. - `chest_pain` (boolean, required): Chest pain associated with syncope (Reed 2010 C). true or false as assigned by the caller. - `q_wave_not_lead_iii` (boolean, required): Q wave not in lead III (Reed 2010 E). true or false as assigned by the caller. magent does not read an ECG. - `spo2_percent` (number, required): Room-air SpO2 percent (50-100). Reed 2010 scores 1 when ≤94; 94 is high-risk. magent does not measure SpO2. ## 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/rose` 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": [ { "bnp_pg_ml": "50", "chest_pain": "false", "fecal_occult_blood": "false", "heart_rate_bpm": "70", "hemoglobin_g_l": "130", "q_wave_not_lead_iii": "false", "spo2_percent": "98" }, { "bnp_pg_ml": "50", "chest_pain": "false", "fecal_occult_blood": "false", "heart_rate_bpm": "70", "hemoglobin_g_l": "130", "q_wave_not_lead_iii": "false", "spo2_percent": "98" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rose Example 200: ```json { "count": 2, "path": "/api/calc/rose", "items": [ { "components": [ { "value": 50.0, "factor": "bnp_ge_300", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate_le_50", "points": 0, "present": false }, { "factor": "fecal_occult_blood", "points": 0, "present": false }, { "value": 130.0, "factor": "hemoglobin_le_90", "points": 0, "present": false }, { "factor": "chest_pain", "points": 0, "present": false }, { "factor": "q_wave_not_lead_iii", "points": 0, "present": false }, { "value": 98.0, "factor": "spo2_le_94", "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": "Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ", "doi": "10.1016/j.jacc.2009.09.049", "id": "reed-2010", "pmid": "20170806", "source": "J Am Coll Cardiol. 2010;55(8):713-721", "title": "The ROSE (Risk Stratification of Syncope in the Emergency Department) Study" }, "formula": "rose", "formula_expression": "ROSE = bnp_ge_300 + heart_rate_le_50 + fecal_occult_blood + hemoglobin_le_90 + chest_pain + q_wave_not_lead_iii + spo2_le_94; each 1 if present; rose_high_risk iff score >= 1; max 7 (Reed 2010 BRACES)", "max_score": 7, "score": 0, "heart_rate_bpm": 70, "spo2_percent": 98.0, "hemoglobin_g_l": 130.0, "bnp_pg_ml": 50.0, "rose_high_risk": false }, { "components": [ { "value": 50.0, "factor": "bnp_ge_300", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate_le_50", "points": 0, "present": false }, { "factor": "fecal_occult_blood", "points": 0, "present": false }, { "value": 130.0, "factor": "hemoglobin_le_90", "points": 0, "present": false }, { "factor": "chest_pain", "points": 0, "present": false }, { "factor": "q_wave_not_lead_iii", "points": 0, "present": false }, { "value": 98.0, "factor": "spo2_le_94", "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": "Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ", "doi": "10.1016/j.jacc.2009.09.049", "id": "reed-2010", "pmid": "20170806", "source": "J Am Coll Cardiol. 2010;55(8):713-721", "title": "The ROSE (Risk Stratification of Syncope in the Emergency Department) Study" }, "formula": "rose", "formula_expression": "ROSE = bnp_ge_300 + heart_rate_le_50 + fecal_occult_blood + hemoglobin_le_90 + chest_pain + q_wave_not_lead_iii + spo2_le_94; each 1 if present; rose_high_risk iff score >= 1; max 7 (Reed 2010 BRACES)", "max_score": 7, "score": 0, "heart_rate_bpm": 70, "spo2_percent": 98.0, "hemoglobin_g_l": 130.0, "bnp_pg_ml": 50.0, "rose_high_risk": false } ] } ``` ## Response fields - `formula` (string): rose - `formula_expression` (string): Exact expression used - `score` (integer): Count of positive BRACES criteria (0-7) - `max_score` (integer): Always 7 - `rose_high_risk` (boolean): true when score ≥ 1 (any BRACES criterion). Not a diagnosis or disposition. - `bnp_pg_ml` (number): BNP used for the ≥300 pg/mL cutoff - `heart_rate_bpm` (integer): Heart rate used for the ≤50 cutoff - `hemoglobin_g_l` (number): Hemoglobin used for the ≤90 g/L cutoff - `spo2_percent` (number): Room-air SpO2 used for the ≤94% cutoff - `components` (array): Per-factor points - `citation` (object): Reed et al. JACC 2010 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 50.0, "factor": "bnp_ge_300", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate_le_50", "points": 0, "present": false }, { "factor": "fecal_occult_blood", "points": 0, "present": false }, { "value": 130.0, "factor": "hemoglobin_le_90", "points": 0, "present": false }, { "factor": "chest_pain", "points": 0, "present": false }, { "factor": "q_wave_not_lead_iii", "points": 0, "present": false }, { "value": 98.0, "factor": "spo2_le_94", "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": "Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ", "doi": "10.1016/j.jacc.2009.09.049", "id": "reed-2010", "pmid": "20170806", "source": "J Am Coll Cardiol. 2010;55(8):713-721", "title": "The ROSE (Risk Stratification of Syncope in the Emergency Department) Study" }, "formula": "rose", "formula_expression": "ROSE = bnp_ge_300 + heart_rate_le_50 + fecal_occult_blood + hemoglobin_le_90 + chest_pain + q_wave_not_lead_iii + spo2_le_94; each 1 if present; rose_high_risk iff score >= 1; max 7 (Reed 2010 BRACES)", "max_score": 7, "score": 0, "heart_rate_bpm": 70, "spo2_percent": 98.0, "hemoglobin_g_l": 130.0, "bnp_pg_ml": 50.0, "rose_high_risk": false } ``` ## Errors - HTTP 400 `invalid_bnp_pg_ml`: bnp_pg_ml must be a number from 0 to 35000 (Reed 2010 ROSE). 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_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_hemoglobin`: hemoglobin_g_l (30-220) or hemoglobin_g_dl (3-22) is required, not both. Returned before settlement; you are not charged. - HTTP 400 `invalid_spo2`: spo2_percent must be a number from 50 to 100. 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 - [San Francisco Syncope Rule](https://magentlab.com/docs/sf-syncope) — Compute the San Francisco Syncope Rule (CHESS) criterion count and rule-positive flag from published cutoffs. - [EGSYS](https://magentlab.com/docs/egsys) — Sum the six Del Rosso 2008 EGSYS flags and return whether the total is ≥3 (published cardiac-syncope triage discriminator). ## 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.