HEART Score
Frames short-term cardiac risk in undifferentiated chest pain when the question is observation, admission, outpatient pathway, or cardiology involvement.
Consult communication tools
Consult and Admission Scores
Risk scores and criteria can help clinicians frame why admission, specialty discussion, or escalation is reasonable when the next step is disputed.
Scores Help Frame the Conversation
Use scores as shared risk language, not as a substitute for clinical judgment. A good score-backed call still needs the clinical question, the trajectory, the workup already done, and the specific decision the receiving team can change.
Guardrails
What These Tools Are Not
- They are not automatic admission, discharge, consult, or procedure rules.
- They should not delay emergency stabilization, local pathway activation, or urgent specialty discussion.
- They should not be used to rule out high-risk disease when clinical concern remains high.
- They work best when paired with the specialty-relevant facts that make the consult answerable.
Admission framing
When Hospitalists Are on the Fence
These scores help turn a vague admission request into a structured risk conversation.
sPESI
Supports PE disposition conversations by separating lower-risk patients from patients whose comorbidities, vitals, or oxygenation make discharge harder to defend.
PSI / PORT
Organizes pneumonia admission discussion around age, comorbidity, exam, vital signs, and objective risk features instead of gestalt alone.
KDIGO AKI Criteria
Gives hospitalists and nephrology a shared stage-based language for creatinine rise, urine output, trajectory, and monitoring intensity.
Glasgow-Blatchford Score
Helps frame upper GI bleed admission and endoscopy discussions by translating labs, vitals, melena/syncope, and comorbidity into risk language.
Consult threshold
When Specialty Involvement Is Uncertain
These scores and criteria help explain why a specialty discussion, procedure, or escalation pathway is reasonable.
LRINEC
Can support concern for necrotizing soft tissue infection, but a low score should not be used to dismiss persistent surgical concern.
Kocher Criteria
Structures ortho discussion for possible septic hip by organizing fever, non-weight-bearing status, inflammatory markers, and WBC context.
Duke Criteria
Gives ID and cardiology a shared framework for bacteremia, echo findings, embolic phenomena, risk factors, and the TEE/workup question.
TIMI
Can help communicate ACS risk and cardiology concern, especially when paired with ECG changes, troponin trend, symptoms, and risk factors.
BISAP
Frames pancreatitis severity and the need for admission, ICU discussion, GI involvement, or surgical/IR source-control thinking.
Tokyo Guidelines
Helps GI, surgery, and IR speak the same language around cholangitis or cholecystitis severity, timing, and source-control options.
Alvarado / AIR
Can organize surgery discussion for appendicitis probability when symptoms, exam, labs, and imaging pathway are not yet aligned.
Use better words
How to Talk About Scores
Say this
"The score supports a higher-risk frame, and the clinical context is why I am calling." Then name the decision: admission, observation, procedure timing, transfer, endoscopy, source control, or specialty evaluation.
Avoid this
Do not say the score proves admission, forces a consult, clears the patient for discharge, or replaces local criteria. Scores should support a thoughtful call, not become a blunt instrument.
Connect it to SIC pages
Use score pages beside the How to Consult pages and the inter-specialty communication guide. The score frames risk; the consult page frames what the receiving service needs to decide.
Educational tool only. SIC provides clinician-facing educational consult-triage references. These scores and criteria are communication aids, not medical advice, disposition rules, procedure rules, or substitutes for clinical judgment, local guidelines, institutional referral pathways, emergency pathways, or specialty department recommendations. See disclaimer and how SIC works.