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Endocrine Abstracts (2022) 86 P366 | DOI: 10.1530/endoabs.86.P366

SFEBES2022 Poster Presentations Thyroid (41 abstracts)

Use of Burch-Wartofsky score when assessing the severity of hyperthyroidism, a retrospective study

Hannah Vennard , Ysaline Duvieusart , Jane McNeilly & Andrew Kernohan

Queen Elizabeth University Hospital, Glasgow, United Kingdom

Introduction: Thyroid storm, a life-threatening endocrine emergency, requires prompt intervention and treatment to improve outcomes. The diagnosis is made clinically, based on symptoms including hyperpyrexia, tachycardia, nausea, diarrhoea and altered cognition. The Burch-Wartofsky (BW) score is a symptom-based score recommended to determine the likelihood of thyroid storm. This retrospective study aims to determine use of the BW scale and its effect on management.

Data collection: The CHI numbers of inpatients with significantly elevated fT4 (>25 pmo/l) at the QEUH labs between Jan-21 and Nov-21 were obtained via Laboratory Information System (LIMS) search. Patients in the maternity, oncology unit, on levothyroxine or with detectable TSH were excluded. Information included: descriptive characteristics, TSH, antibody status and acute diagnosis/treatment. BW score and outcome, was retrospectively calculated using patient notes.

Results: BW score was used clinically in 1/51 patients included. Most patients were diagnosed clinically with “acute thyrotoxicosis,” however, the opinion of an endocrinologist was not always sought. Of 29 patients with a BW score indicating ‘storm unlikely’ none were clinically identified at risk of deterioration. Of 15 patients with a BW score suggesting ‘impending storm’, 1 was identified clinically as impending storm. Of 7 patients with a BW score indicating ‘thyroid storm’, 2 were clinically diagnosed with thyroid storm. BW score never suggested a less severe diagnosis, in 6 instances the BW score suggested a more severe diagnosis than the clinical decision. A weak positive correlation between BW score and fT4 was noted (spearman co-efficient: 0.28, P<0.05).

Conclusions: The use of the BW score in clinical practice would standardise classification of patients; subsequently, identifying patients at higher risk of clinical deterioration, requiring prompt treatment. As a result of this first audit cycle, we are discussing with clinical biochemistry issuing reports to recommend endocrinology review and encourage use of BW scale where appropriate.

Volume 86

Society for Endocrinology BES 2022

Harrogate, United Kingdom
14 Nov 2022 - 16 Nov 2022

Society for Endocrinology 

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