Baltimore Sepsis Scale - Medical Algorithm

Description

The Baltimore Sepsis Scale provides a daily measure of disease severity in a patient with the sepsis syndrome. It can be used to monitor a patient over time and to evaluate the effectiveness of interventions. It was developed in Baltimore, Maryland.

Parts of the scale:

(1) physiologic measures (based on daily findings)

(2) modified Glasgow Coma Scale

Parameter	Point Assignment	Maximum Points per Day
tachycardia	1 point for each 10 beats per minute > 120	none
systolic blood pressure	1 point for each 10 mm Hg < 90, OR 1 point for each cumulative 10 µg pressor	none
body temperature	1 point for each °C > 38.5 OR 1 point for each °C < 36.0	none
base deficit	1 point for each 3 mmol/L > 5	none
platelet count	1 point for each 5,000 < 35,000 per µL	none (7)
white blood cell count	1 point for each 5,000 > 15,000 per µL	none
creatinine	1 point for each 2 mg/dL > 2 mg/dL, OR patient on dialysis	5
systemic vascular resistance	1 point for each 100 < 800 dynes per second per cm^(-5)	none (8)
urine output	1 point for each 50 mL/day < 500 mL/day	none (10)
PEEP	1 point for each 3 mm > 5 mm Hg	none
PaO2 to FIO2 ratio	1 point for each 0.3 < 2.0	none

where:

• systolic blood pressure has 2 possible scoring methods: (a) maximum points for either low pressure or pressor use, or (b) combination of points for each. I will use (b) in the implementation.

• base deficit is the negative of base excess

• an elevated WBC count from leukemia would cause a falsely high value

• FIO2 appears to be from 21 to 100 (percent rather than fraction)

• maximal value: tachycardia, base deficit, WBC count, creatinine, PEEP

• minimal value: systolic blood pressure, platelet count, systemic vascular resistance, PaO2 to FIO2 ratio

• either, whichever is greater from baseline: temperature

• cumulative value: pressor dose, urine output

• it appears as if points are assigned as each milestone is reached, rather than on the continuum

Modified Glasgow Coma Scale

Clinical Finding	Points
oriented to person, place and time (x3) and cooperative	1
occasional confusion but mostly oriented	2
frequent confusion but cooperative, tries to help with dressings, recognizes family and staff	3
semiconscious or delirious most of the time, cannot help with dressings, does not recognize family or friends	4
expresses pain response to stimulation, no other response	5
coma, with no pain response	6

Baltimore sepsis scale =

= (points for physiologic findings) + (points for modified Glasgow Coma Scale)

Interpretation:

• minimum score: 1

• maximum score: 200+

• In practice the highest score observed in patients at any time is 50.

• The higher the score, the more severe the sepsis syndrome.

Sepsis Scale	Interpretation
0 – 10	The patient is injured but doing well.
11 – 20	The patient is having problems.
21 – 30	The patient is gravely ill.
> 30	The patient is in critical condition and has multiple organ failure.

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Description

Specialty

Objective

ICD-10

The Baltimore Sepsis Scale

Purpose: To evaluate a patient with the sepsis syndrome using the Baltimore Sepsis Scale.

Description

Specialty

Objective

ICD-10