Age, year

Heart rate

If patient had both cardiac arrest (11 points) and extreme tachycardia (7 points), assign 11 points

Systolic BP, mmHg

Worst value in 24 hours

Temperature ≥39ºC (102.2ºF)

Highest temperature in 24 hours

Glasgow Coma Scale/Score

Lowest value in 24 hours; if patient is sedated, record estimated GCS before sedation

PaO₂/FiO₂, if on mechanical ventilation or CPAP

Use lowest value in 24 hours; if patient was extubated <24 hours ago, use lowest value while on mechanical ventilation

BUN, mg/dL or serum urea, mmol/L

Urine output, mL/day

If in ICU <24 hours, calculate for 24 hours (e.g. if 1 L in 8 hours, then mark 3 L in 24 hours)

Sodium, mEq/L or mmol/L

Worst value in 24 hours

Potassium, mEq/L

Worst value in 24 hours

Bicarbonate, mEq/L

Lowest value in 24 hours


Highest value in 24 hours

WBC, x 10³/mm³

Worst value in 24 hours

Chronic disease

Type of admission

Scheduled surgical = surgery scheduled ≥24 hours prior; medical = no surgery within 1 week of admission; unscheduled surgical = surgery scheduled ≤24 hours prior
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