# Shapiro blood culture rule Shapiro blood culture rule Status: LIVE Price: $0.005 USDC `GET /api/calc/shapiro` HTML: https://magentlab.com/docs/shapiro Markdown: https://magentlab.com/docs/shapiro.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Shapiro 2008 major/minor blood-culture prediction rule and return whether culture is indicated from caller-assigned findings and labs. ## When to use When an agent has caller-assigned adult ED findings and labs and needs the Shapiro 2008 prediction rule for whether blood culture is indicated, not a culture order and not a sepsis diagnosis. ## When not to use - Not a medical device. Not a diagnosis of bacteremia, sepsis, or endocarditis. magent does not examine the patient. - magent does not draw blood cultures or order cultures. culture_indicated is the published 2008 rule only. - Shapiro 2008 major/minor rule only (indicated if ≥1 major or ≥2 minor). Not a later point encoding of the same items. - Temperature major (>39.5 °C) and minor (38.3–39.4 °C) are derived from one temperature_c; they cannot both be true. 39.5 °C is neither band. - Age >65 is a minor; 65 is not. Hypotension is a caller-assigned flag for systolic blood pressure <90 mm Hg; magent does not take a blood pressure. - The caller assigns every flag and lab. magent does not inspect catheters, diagnose endocarditis, or assay a CBC or creatinine. - Published for adults ≥18 years undergoing ED blood-culture decisions. Not SIRS, not qSOFA, and not a sepsis protocol. ## Formula ``` culture indicated if ≥1 major (temperature_c > 39.5, catheter, suspected_endocarditis) or ≥2 minor (temperature_c 38.3–39.4, age > 65, chills, vomiting, hypotension, neutrophil_percent > 80, wbc_k > 18, bands_percent > 5, platelets_k < 150, creatinine_mg_dl > 2.0) (Shapiro 2008) ``` ## Citation [Who needs a blood culture? A prospectively derived and validated prediction rule](https://doi.org/10.1016/j.jemermed.2008.04.001) Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW J Emerg Med. 2008;35(3):255-264 DOI: [10.1016/j.jemermed.2008.04.001](https://doi.org/10.1016/j.jemermed.2008.04.001) ## Worked example ### No major or minor criteria Given: `age=40, bands_percent=2, catheter=false, chills=false, creatinine_mg_dl=1.0, hypotension=false, neutrophil_percent=70, platelets_k=250, suspected_endocarditis=false, temperature_c=37.0, vomiting=false, wbc_k=10` 1. Age 40 is not >65; temperature 37.0 °C is neither >39.5 nor 38.3–39.4 2. Catheter, endocarditis suspicion, chills, vomiting, and hypotension are false 3. Labs are outside every minor cutoff (0 major, 0 minor) 4. Culture is not indicated ### One major (indwelling catheter) Given: `age=40, bands_percent=2, catheter=true, chills=false, creatinine_mg_dl=1.0, hypotension=false, neutrophil_percent=70, platelets_k=250, suspected_endocarditis=false, temperature_c=37.0, vomiting=false, wbc_k=10` 1. Indwelling vascular catheter is a major criterion 2. Culture is indicated (≥1 major) ### Two minors without a major Given: `age=40, bands_percent=2, catheter=false, chills=true, creatinine_mg_dl=1.0, hypotension=false, neutrophil_percent=70, platelets_k=250, suspected_endocarditis=false, temperature_c=37.0, vomiting=true, wbc_k=10` 1. No major criterion 2. Chills and vomiting are two minor criteria 3. Culture is indicated (≥2 minor) ## Also searched as - Shapiro blood culture rule - Shapiro bacteremia rule - who needs a blood culture - blood culture prediction rule - Shapiro 2008 criteria - major minor blood culture criteria - ED blood culture rule ## Parameters - `age` (integer, required): Age in years (integer 18-120). Age >65 is a Shapiro 2008 minor criterion; 65 is not. The published rule is for adults ≥18 years. - `temperature_c` (number, required): Temperature in °C (30.0-45.0). Major when >39.5 (39.5 is not). Minor when 38.3–39.4 inclusive. magent does not measure temperature. - `catheter` (boolean, required): Indwelling vascular catheter (Shapiro 2008 major). true or false as assigned by the caller. magent does not inspect lines. - `suspected_endocarditis` (boolean, required): Clinical suspicion of endocarditis (Shapiro 2008 major). true or false as assigned by the caller. magent does not diagnose endocarditis. - `chills` (boolean, required): Chills (Shapiro 2008 minor). true or false as assigned by the caller. magent does not take a history. - `vomiting` (boolean, required): Vomiting (Shapiro 2008 minor). true or false as assigned by the caller. magent does not observe vomiting. - `hypotension` (boolean, required): Hypotension (Shapiro 2008 minor: systolic blood pressure < 90 mm Hg). true or false as assigned by the caller. magent does not measure blood pressure. - `neutrophil_percent` (number, required): Neutrophil percent (0-100). Shapiro 2008 minor when >80 (80 does not). magent does not assay a CBC. - `wbc_k` (number, required): White blood cell count in thousands (0-500; same as 10^3/µL). Shapiro 2008 minor when >18 (18 does not). magent does not assay a CBC. - `bands_percent` (number, required): Band percent (0-100). Shapiro 2008 minor when >5 (5 does not). magent does not assay a CBC. - `platelets_k` (number, required): Platelet count in thousands (0-2000; same as 10^3/µL). Shapiro 2008 minor when <150 (150 does not). magent does not assay a CBC. - `creatinine_mg_dl` (number, required): Creatinine in mg/dL (0.1-20.0). Shapiro 2008 minor when >2.0 (2.0 does not). magent does not assay creatinine. ## 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/shapiro` 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": [ { "age": "40", "bands_percent": "2", "catheter": "false", "chills": "false", "creatinine_mg_dl": "1.0", "hypotension": "false", "neutrophil_percent": "70", "platelets_k": "250", "suspected_endocarditis": "false", "temperature_c": "37.0", "vomiting": "false", "wbc_k": "10" }, { "age": "40", "bands_percent": "2", "catheter": "false", "chills": "false", "creatinine_mg_dl": "1.0", "hypotension": "false", "neutrophil_percent": "70", "platelets_k": "250", "suspected_endocarditis": "false", "temperature_c": "37.0", "vomiting": "false", "wbc_k": "10" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/shapiro Example 200: ```json { "count": 2, "path": "/api/calc/shapiro", "items": [ { "age": 40, "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": "Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW", "doi": "10.1016/j.jemermed.2008.04.001", "id": "shapiro-2008", "pmid": "18486413", "source": "J Emerg Med. 2008;35(3):255-264", "title": "Who needs a blood culture? A prospectively derived and validated prediction rule" }, "formula": "shapiro", "formula_expression": "culture indicated if ≥1 major (temperature_c > 39.5, catheter, suspected_endocarditis) or ≥2 minor (temperature_c 38.3–39.4, age > 65, chills, vomiting, hypotension, neutrophil_percent > 80, wbc_k > 18, bands_percent > 5, platelets_k < 150, creatinine_mg_dl > 2.0) (Shapiro 2008)", "temperature_c": 37.0, "criteria": [ { "value": 37.0, "factor": "temperature_gt_39_5", "met": false }, { "factor": "catheter", "met": false }, { "factor": "suspected_endocarditis", "met": false }, { "value": 37.0, "factor": "temperature_38_3_to_39_4", "met": false }, { "value": 40, "factor": "age_gt_65", "met": false }, { "factor": "chills", "met": false }, { "factor": "vomiting", "met": false }, { "factor": "hypotension", "met": false }, { "value": 70.0, "factor": "neutrophil_gt_80", "met": false }, { "value": 10.0, "factor": "wbc_gt_18k", "met": false }, { "value": 2.0, "factor": "bands_gt_5", "met": false }, { "value": 250.0, "factor": "platelets_lt_150k", "met": false }, { "value": 1.0, "factor": "creatinine_gt_2", "met": false } ], "major_count": 0, "minor_count": 0, "culture_indicated": false }, { "age": 40, "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": "Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW", "doi": "10.1016/j.jemermed.2008.04.001", "id": "shapiro-2008", "pmid": "18486413", "source": "J Emerg Med. 2008;35(3):255-264", "title": "Who needs a blood culture? A prospectively derived and validated prediction rule" }, "formula": "shapiro", "formula_expression": "culture indicated if ≥1 major (temperature_c > 39.5, catheter, suspected_endocarditis) or ≥2 minor (temperature_c 38.3–39.4, age > 65, chills, vomiting, hypotension, neutrophil_percent > 80, wbc_k > 18, bands_percent > 5, platelets_k < 150, creatinine_mg_dl > 2.0) (Shapiro 2008)", "temperature_c": 37.0, "criteria": [ { "value": 37.0, "factor": "temperature_gt_39_5", "met": false }, { "factor": "catheter", "met": false }, { "factor": "suspected_endocarditis", "met": false }, { "value": 37.0, "factor": "temperature_38_3_to_39_4", "met": false }, { "value": 40, "factor": "age_gt_65", "met": false }, { "factor": "chills", "met": false }, { "factor": "vomiting", "met": false }, { "factor": "hypotension", "met": false }, { "value": 70.0, "factor": "neutrophil_gt_80", "met": false }, { "value": 10.0, "factor": "wbc_gt_18k", "met": false }, { "value": 2.0, "factor": "bands_gt_5", "met": false }, { "value": 250.0, "factor": "platelets_lt_150k", "met": false }, { "value": 1.0, "factor": "creatinine_gt_2", "met": false } ], "major_count": 0, "minor_count": 0, "culture_indicated": false } ] } ``` ## Response fields - `formula` (string): shapiro - `formula_expression` (string): Shapiro 2008 rule: culture if ≥1 major or ≥2 minor - `culture_indicated` (boolean): true when ≥1 major criterion or ≥2 minor criteria are met (Shapiro 2008). Not a diagnosis and not a culture order. - `major_count` (integer): Count of major criteria met (0-3) - `minor_count` (integer): Count of minor criteria met (0-10) - `age` (integer): Age used for the age >65 minor criterion - `temperature_c` (number): Temperature in °C used for the >39.5 major and 38.3–39.4 minor bands - `criteria` (array): Per-factor rows with factor and met; temperature, age, and lab rows include value - `citation` (object): Shapiro 2008 J Emerg Med citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "age": 40, "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": "Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW", "doi": "10.1016/j.jemermed.2008.04.001", "id": "shapiro-2008", "pmid": "18486413", "source": "J Emerg Med. 2008;35(3):255-264", "title": "Who needs a blood culture? A prospectively derived and validated prediction rule" }, "formula": "shapiro", "formula_expression": "culture indicated if ≥1 major (temperature_c > 39.5, catheter, suspected_endocarditis) or ≥2 minor (temperature_c 38.3–39.4, age > 65, chills, vomiting, hypotension, neutrophil_percent > 80, wbc_k > 18, bands_percent > 5, platelets_k < 150, creatinine_mg_dl > 2.0) (Shapiro 2008)", "temperature_c": 37.0, "criteria": [ { "value": 37.0, "factor": "temperature_gt_39_5", "met": false }, { "factor": "catheter", "met": false }, { "factor": "suspected_endocarditis", "met": false }, { "value": 37.0, "factor": "temperature_38_3_to_39_4", "met": false }, { "value": 40, "factor": "age_gt_65", "met": false }, { "factor": "chills", "met": false }, { "factor": "vomiting", "met": false }, { "factor": "hypotension", "met": false }, { "value": 70.0, "factor": "neutrophil_gt_80", "met": false }, { "value": 10.0, "factor": "wbc_gt_18k", "met": false }, { "value": 2.0, "factor": "bands_gt_5", "met": false }, { "value": 250.0, "factor": "platelets_lt_150k", "met": false }, { "value": 1.0, "factor": "creatinine_gt_2", "met": false } ], "major_count": 0, "minor_count": 0, "culture_indicated": false } ``` ## Errors - HTTP 400 `invalid_shapiro`: Shapiro-rule inputs must be the 2008 major and minor bacteremia criteria (temperature, catheter, endocarditis suspicion, age, chills, vomiting, hypotension, and listed labs). 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 - [SIRS](https://magentlab.com/docs/sirs) — Compute the Bone 1992 ACCP/SCCM SIRS criteria from temperature, heart rate, respiratory rate, and WBC, with optional PaCO2 and band percent. - [qSOFA](https://magentlab.com/docs/qsofa) — Compute the Sepsis-3 qSOFA score from respiratory rate, caller-assigned altered mentation, and systolic blood pressure. ## 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.