cliot (version 1.0.0)

action_icu_nstemi: ACTION ICU Score for NSTEMI

Description

Calculates the ACTION ICU Score to predict the risk of in-hospital complications (cardiac arrest, shock, high-grade AV block, respiratory failure, stroke, or death) in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI). This tool helps triage patients who may benefit from Intensive Care Unit (ICU) admission versus those who can be safely managed in a non-ICU setting (e.g., step-down or telemetry unit).

Usage

action_icu_nstemi(age, creatinine, heart_rate, sbp, troponin_x_uln,
                  heart_failure, st_depression, prior_revasc, chronic_lung_disease)

Value

A list containing:

Total_Score

The calculated ACTION ICU Score (Range 0-17).

Risk_Prediction

Estimated risk of complications requiring ICU care.

Recommendation

Guidance on ICU vs. non-ICU admission based on the score threshold of 5.

Arguments

age

Numeric. Patient age in years. (>= 70 years adds +1 point).

creatinine

Numeric. Serum creatinine in mg/dL. (>= 1.1 mg/dL adds +1 point).

heart_rate

Numeric. Heart rate in beats per minute (bpm). (< 85: 0 points; 85-100: +1 point; >= 100: +3 points).

sbp

Numeric. Systolic blood pressure in mmHg. (< 125: +3 points; 125-145: +1 point; > 145: 0 points).

troponin_x_uln

Numeric. Initial troponin level expressed as a multiple of the Upper Limit of Normal (e.g., if Troponin is 0.5 and ULN is 0.1, input 5). (>= 12x ULN adds +2 points).

heart_failure

Numeric (0 or 1). Signs or symptoms of heart failure on admission. (Yes adds +5 points).

st_depression

Numeric (0 or 1). ST-segment depression on ECG. (Yes adds +1 point).

prior_revasc

Numeric (0 or 1). History of prior coronary revascularization (PCI or CABG). Note: **Absence** of prior revascularization adds risk in this model. (No = +1 point; Yes = 0 points).

chronic_lung_disease

Numeric (0 or 1). History of chronic lung disease (e.g., COPD). (Yes adds +2 points).

References

Fanari Z, et al. Risk Score to Predict Need for Intensive Care in Initially Hemodynamically Stable Adults With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc. 2018;7(11):e008894. doi:10.1161/JAHA.118.008894

Examples

# Example 1: High Risk Candidate for ICU
# 72yo (+1), Cr 1.5 (+1), HR 110 (+3), SBP 110 (+3), HF present (+5), No prior revasc (+1)
# Score = 14 -> High Risk
action_icu_nstemi(72, 1.5, 110, 110, 5, 1, 0, 0, 0)

# Example 2: Low Risk (Floor Candidate)
# 60yo (0), Cr 0.9 (0), HR 70 (0), SBP 150 (0), Trop 2x (0), No HF (0), Prior Revasc (0)
# Score = 0
action_icu_nstemi(60, 0.9, 70, 150, 2, 0, 0, 1, 0)