# Sudbury vertigo risk score (Ohle 2025) Sudbury Vertigo Status: LIVE Price: $0.005 USDC `GET /api/calc/sudbury_vertigo` HTML: https://magentlab.com/docs/sudbury-vertigo Markdown: https://magentlab.com/docs/sudbury-vertigo.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum Ohle 2025 Table 2 Sudbury vertigo points from sex, age>65 flag, diabetes, hypertension, motor or sensory deficit, cerebellar signs, and BPPV diagnosis, and return the Table 3 serious-cause band and the score>4 investigate_further cutoff. ## When to use When an agent has the published Ohle 2025 ED vertigo flags and needs the Table 2 total, Table 3 grouped serious-cause percent, and the score>4 operating cutoff, and must not invent a HINTS exam, a stroke diagnosis, a CT order, or an integer age. ## When not to use - Not a medical device. Not a stroke diagnosis or CT order. - magent does not examine the patient. Cerebellar signs and motor or sensory deficit are caller-assigned. - Not HINTS and not HINTS-plus. This is the Ohle 2025 ED serious-cause-of-vertigo risk score, not a bedside HINTS exam. - age_gt_65 is the published age >65 flag, not years. Age 65 scores 0. Do not send an integer age. - Serious-cause percents are Ohle 2025 Table 3 grouped bands only (score <5 / 5-8 / >8: 0.0 / 2.1 / 41.0). Per-integer percents are not attached. Female + BPPV is -5 and is not clamped. max_score is 17 (positive weights; BPPV is negative and not in the max). - investigate_further is the paper operating cutoff score >4 (sensitivity 100% / specificity 72.1%). It is not an imaging or admission order. ## Formula ``` Sudbury vertigo = male 1 + age_gt_65 1 + diabetes 1 + hypertension 3 + motor_or_sensory_deficit 5 + cerebellar_signs 6 + bppv_diagnosis -5; Ohle 2025 Table 2; Table 3 bands score <5 -> 0.0%, 5-8 -> 2.1%, >8 -> 41.0%; investigate_further iff score >4; max 17 (sum of positive weights; BPPV is negative and not in the max); do not clamp ``` ## Citation [Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department](https://doi.org/10.1016/j.annemergmed.2024.06.003) Ohle R, Savage DW, Roy D, et al. Ann Emerg Med. 2025;85(2):122-131 DOI: [10.1016/j.annemergmed.2024.06.003](https://doi.org/10.1016/j.annemergmed.2024.06.003) ## Worked example ### Female, no flags (band lt_5) Given: `age_gt_65=false, bppv_diagnosis=false, cerebellar_signs=false, diabetes=false, hypertension=false, motor_or_sensory_deficit=false, sex=female` 1. Female → 0; age_gt_65 false → 0; diabetes false → 0; hypertension false → 0; motor_or_sensory_deficit false → 0; cerebellar_signs false → 0; bppv_diagnosis false → 0 2. Score = 0; band lt_5; Table 3 serious-cause percent 0.0%; investigate_further false ### Hypertension only (band lt_5) Given: `age_gt_65=false, bppv_diagnosis=false, cerebellar_signs=false, diabetes=false, hypertension=true, motor_or_sensory_deficit=false, sex=female` 1. Hypertension → 3; remaining Table 2 items 0 2. Score = 3; band lt_5; Table 3 serious-cause percent 0.0%; investigate_further false ### Male, age>65, diabetes, and hypertension (band 5_to_8) Given: `age_gt_65=true, bppv_diagnosis=false, cerebellar_signs=false, diabetes=true, hypertension=true, motor_or_sensory_deficit=false, sex=male` 1. Male → 1; age_gt_65 → 1; diabetes → 1; hypertension → 3 2. Score = 6; band 5_to_8; Table 3 serious-cause percent 2.1%; investigate_further true ### Cerebellar signs and motor or sensory deficit (band gt_8) Given: `age_gt_65=false, bppv_diagnosis=false, cerebellar_signs=true, diabetes=false, hypertension=false, motor_or_sensory_deficit=true, sex=female` 1. cerebellar_signs → 6; motor_or_sensory_deficit → 5 2. Score = 11; band gt_8; Table 3 serious-cause percent 41.0%; investigate_further true ### Female and BPPV only (score -5, band lt_5) Given: `age_gt_65=false, bppv_diagnosis=true, cerebellar_signs=false, diabetes=false, hypertension=false, motor_or_sensory_deficit=false, sex=female` 1. Female → 0; bppv_diagnosis → -5 2. Score = -5 (not clamped); band lt_5; Table 3 serious-cause percent 0.0%; investigate_further false ## Also searched as - Sudbury vertigo score - Ohle 2025 vertigo - ED vertigo risk score - serious cause of vertigo - Ohle vertigo clinical risk score - age greater than 65 vertigo - BPPV vertigo risk score - Sudbury ED vertigo ## Parameters - `sex` (string, required): female or male (Ohle 2025 Table 2). Male scores 1. Female scores 0. Assigned by the caller. Do not send a male boolean. - `age_gt_65` (boolean, required): Age greater than 65 as a published yes/no flag (Ohle 2025 Table 2). true scores 1. Age 65 scores 0. true or false. Do not send years. magent does not measure age. - `diabetes` (boolean, required): Diabetes as assigned by the caller (Ohle 2025 Table 2). true or false. 1 point if true. magent does not examine the patient. - `hypertension` (boolean, required): Hypertension as assigned by the caller (Ohle 2025 Table 2). true or false. 3 points if true. magent does not measure blood pressure. - `motor_or_sensory_deficit` (boolean, required): Motor or sensory deficit as assigned by the caller (Ohle 2025 Table 2). true or false. 5 points if true. magent does not examine the patient. - `cerebellar_signs` (boolean, required): Cerebellar signs as assigned by the caller (Ohle 2025 Table 2 footnote: diplopia, dysarthria, dysphagia, dysmetria, ataxia). true or false. 6 points if true. magent does not examine the patient. - `bppv_diagnosis` (boolean, required): BPPV diagnosis as assigned by the caller (Ohle 2025 Table 2). true or false. -5 points if true. magent does not examine the patient. ## 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/sudbury_vertigo` 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_gt_65": "false", "bppv_diagnosis": "false", "cerebellar_signs": "false", "diabetes": "false", "hypertension": "false", "motor_or_sensory_deficit": "false", "sex": "female" }, { "age_gt_65": "false", "bppv_diagnosis": "false", "cerebellar_signs": "false", "diabetes": "false", "hypertension": "false", "motor_or_sensory_deficit": "false", "sex": "female" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/sudbury-vertigo Example 200: ```json { "count": 2, "path": "/api/calc/sudbury_vertigo", "items": [ { "components": [ { "value": "female", "factor": "sex", "points": 0, "present": false }, { "factor": "age_gt_65", "points": 0, "present": false }, { "factor": "diabetes", "points": 0, "present": false }, { "factor": "hypertension", "points": 0, "present": false }, { "factor": "motor_or_sensory_deficit", "points": 0, "present": false }, { "factor": "cerebellar_signs", "points": 0, "present": false }, { "factor": "bppv_diagnosis", "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": "Ohle R, Savage DW, Roy D, et al.", "doi": "10.1016/j.annemergmed.2024.06.003", "id": "ohle-2025", "pmid": "39093245", "source": "Ann Emerg Med. 2025;85(2):122-131", "title": "Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department" }, "formula": "sudbury_vertigo", "formula_expression": "Sudbury vertigo = male 1 + age_gt_65 1 + diabetes 1 + hypertension 3 + motor_or_sensory_deficit 5 + cerebellar_signs 6 + bppv_diagnosis -5; Ohle 2025 Table 2; Table 3 bands score <5 -> 0.0%, 5-8 -> 2.1%, >8 -> 41.0%; investigate_further iff score >4; max 17 (sum of positive weights; BPPV is negative and not in the max); do not clamp", "max_score": 17, "score": 0, "sex": "female", "diabetes": false, "age_gt_65": false, "bppv_diagnosis": false, "cerebellar_signs": false, "hypertension": false, "investigate_further": false, "motor_or_sensory_deficit": false, "serious_cause_percent": 0.0, "sudbury_band": "lt_5" }, { "components": [ { "value": "female", "factor": "sex", "points": 0, "present": false }, { "factor": "age_gt_65", "points": 0, "present": false }, { "factor": "diabetes", "points": 0, "present": false }, { "factor": "hypertension", "points": 0, "present": false }, { "factor": "motor_or_sensory_deficit", "points": 0, "present": false }, { "factor": "cerebellar_signs", "points": 0, "present": false }, { "factor": "bppv_diagnosis", "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": "Ohle R, Savage DW, Roy D, et al.", "doi": "10.1016/j.annemergmed.2024.06.003", "id": "ohle-2025", "pmid": "39093245", "source": "Ann Emerg Med. 2025;85(2):122-131", "title": "Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department" }, "formula": "sudbury_vertigo", "formula_expression": "Sudbury vertigo = male 1 + age_gt_65 1 + diabetes 1 + hypertension 3 + motor_or_sensory_deficit 5 + cerebellar_signs 6 + bppv_diagnosis -5; Ohle 2025 Table 2; Table 3 bands score <5 -> 0.0%, 5-8 -> 2.1%, >8 -> 41.0%; investigate_further iff score >4; max 17 (sum of positive weights; BPPV is negative and not in the max); do not clamp", "max_score": 17, "score": 0, "sex": "female", "diabetes": false, "age_gt_65": false, "bppv_diagnosis": false, "cerebellar_signs": false, "hypertension": false, "investigate_further": false, "motor_or_sensory_deficit": false, "serious_cause_percent": 0.0, "sudbury_band": "lt_5" } ] } ``` ## Response fields - `formula` (string): sudbury_vertigo - `formula_expression` (string): Exact Ohle 2025 Table 2 expression - `score` (integer): Ohle 2025 Table 2 points. Theoretical paper range -4 to 17 (male+BPPV = -4). Female + BPPV only is -5 and is allowed; not clamped. - `max_score` (integer): Always 17 (sum of positive weights; BPPV is negative and not in the max) - `sudbury_band` (string): Ohle 2025 Table 3 grouped band: lt_5 if score <5, 5_to_8 if 5<=score<=8, gt_8 if score >8. Not a per-integer rate. - `serious_cause_percent` (number): Ohle 2025 Table 3 grouped serious-cause percent for that band (0.0 / 2.1 / 41.0). Not a per-integer percent. - `investigate_further` (boolean): true iff score >4 (Ohle 2025 operating cutoff: sensitivity 100% / specificity 72.1%). Not a CT or admission order. - `sex` (string): Sex used: female or male - `age_gt_65` (boolean): Caller-assigned age >65 flag used (not years) - `diabetes` (boolean): Caller-assigned diabetes flag used - `hypertension` (boolean): Caller-assigned hypertension flag used - `motor_or_sensory_deficit` (boolean): Caller-assigned motor or sensory deficit flag used - `cerebellar_signs` (boolean): Caller-assigned cerebellar signs flag used - `bppv_diagnosis` (boolean): Caller-assigned BPPV diagnosis flag used - `components` (array): Per-factor points for the seven Ohle 2025 Table 2 items - `citation` (object): Ohle et al. Ann Emerg Med 2025 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": "female", "factor": "sex", "points": 0, "present": false }, { "factor": "age_gt_65", "points": 0, "present": false }, { "factor": "diabetes", "points": 0, "present": false }, { "factor": "hypertension", "points": 0, "present": false }, { "factor": "motor_or_sensory_deficit", "points": 0, "present": false }, { "factor": "cerebellar_signs", "points": 0, "present": false }, { "factor": "bppv_diagnosis", "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": "Ohle R, Savage DW, Roy D, et al.", "doi": "10.1016/j.annemergmed.2024.06.003", "id": "ohle-2025", "pmid": "39093245", "source": "Ann Emerg Med. 2025;85(2):122-131", "title": "Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department" }, "formula": "sudbury_vertigo", "formula_expression": "Sudbury vertigo = male 1 + age_gt_65 1 + diabetes 1 + hypertension 3 + motor_or_sensory_deficit 5 + cerebellar_signs 6 + bppv_diagnosis -5; Ohle 2025 Table 2; Table 3 bands score <5 -> 0.0%, 5-8 -> 2.1%, >8 -> 41.0%; investigate_further iff score >4; max 17 (sum of positive weights; BPPV is negative and not in the max); do not clamp", "max_score": 17, "score": 0, "sex": "female", "diabetes": false, "age_gt_65": false, "bppv_diagnosis": false, "cerebellar_signs": false, "hypertension": false, "investigate_further": false, "motor_or_sensory_deficit": false, "serious_cause_percent": 0.0, "sudbury_band": "lt_5" } ``` ## Errors - HTTP 400 `invalid_sex`: sex must be female or male 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 - [HINTS](https://magentlab.com/docs/hints) — Apply the Kattah 2009 three-step HINTS exam (Head-Impulse, Nystagmus, Test-of-Skew) from three caller-assigned flags and return whether any dangerous central sign is present. ## 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.