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Medical Criteria – R

by Dr.NM Tamilmani
April 13, 2024
in Criteria
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Medical Criteria – R


RIGHT BUNDLE BRANCH BLOCK (RBBB):

  • Complete RBBB
    • QRS duration >120 msec
    • Positive QRS in lead V1 (rSR’ or occasionally broad R wave)
    • Broad S waves in leads I, V5-6 (>40 msec)
    • Usually, secondary T wave inversion in leads V1-2
    • Frontal axis determination using only the first 60 msec
    • RBBB: V1 is positive (rSR’), V6 has broad S wave
  • Right Ventricular Hypertrophy (RVH):
    • Right axis deviation
    • R/S ratio >1 or qR in lead V1
    • RV strain pattern: ST segment depression and T wave inversion in leads V1-2
  • Right Atrial Enlargement (RAE):
    • P wave >2.5 mm in height in leads II, III, or aVF (“P pulmonale”)

RANSON’S CRITERIA:

  • At admission
    • Age >55 yr
    • WBC >16 x 109/L
    • Glucose >11 mmol/L
    • LDH ≥350 IU/L
    • AST >250 IU/L
  • During initial 48 h
    • Hct drop >10%
    • BUN rise >1.8 mmol/L
    • Arterial PO2 <60 mmHg
    • Base deficit >4 mmol/L
    • Calcium <2 mmol/L
    • Fluid sequestration >6 L
  • Interpretation
    • ≥2 = difficult course
    • ≥3 = high mortality (≥15%

ROME IV DIAGNOSTIC CRITERIA:

  • Straining, hard stools, sensation of incomplete evacuation, use of digital manoeuvres, and/or sensation of anorectal obstruction/blockage with 25% of bowel movements and <3 bowel movements per wk. The criteria must be fulfilled for the last 3 months with symptom onset ≥ 6 months prior to diagnosis.

ROCHESTER CRITERIA

  • Developed to Identify Infants ≤60 d of Age with Fever at Low Risk of Serious Bacterial Infection
Clinically
  • Well
WBC Count
  • 5-15 x 109/L
Bands
  • <1.5 x 109/L
Urinalysis
  • <10 WBC/HPF
Stool (if diarrhoea)
  • <5 WBC/HPF
Past Health
  • Born >37 wks.
  • Home with/before mom
  • No hospitalizations
  • No prior antibiotic use
  • No prior treatment
  • for unexplained
  • hyperbilirubinemia
  • No chronic disease

RHEUMATIC FEVER:

  • Clinical diagnosis based on Jones Criteria (revised)
    • Requires 2 major OR 1 major and 2 minors PLUS evidence of preceding strep infection (history of scarlet fever, GAS pharyngitis culture, positive rapid Ag detection test, ASOTs)

PULMONARY EMBOLISM RULE OUT CRITERIA (PERC):

  • Prospective Multicentre Evaluation of the Pulmonary Embolism Rule Out Criteria
    • J Thromb Hemost 2008; 6:772
      • Age less than 50 yrs.
      • Heart rate less than 100 bpm
      • Oxyhaemoglobin saturation ≥95 percent
      • No haemoptysis
      • No estrogen use
      • No prior DVT or PE
      • No unilateral leg swelling
      • No surgery or trauma requiring hospitalization within the past 4 wks.
  • Acute PE can probably be excluded without further diagnostic testing if the patient meets all PERC criteria AND there is a low clinical suspicion for PE, according to either the Wells’ criteria or a low gestalt probability determined by the clinician prior to diagnostic testing for PE.

RHEUMATOID ARTHRITIS:

  • 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis

(Score-based algorithm: add score of categories A-D; a score of 6/10 for definite Rheumatoid Arthritis)

Criteria Score Comments
A. Joint involvement (swollen or tender)

  • 1 large joint (shoulders, elbows, hips, knees, and ankles)
  • 2-10 large joints
  • 1-3 small joints (MCPs, PIPs, wrists, 2nd-5th MTPs)
  • 4-10 small joints

>10 joints (at least 1 small joint)

 

0

1

2

3

5

 

 

 

 

 

 

 

Total score of ≥6: Definite Rheumatoid Arthritis

Must have ≥1 joint with definite clinical swelling, not better explained by other disease

B. Serology

  • Negative RF and negative Anti-CCP
  • Low-positive RF or low-positive Anti-CCP (<3x ULN)
  • High-positive RF or high-positive Anti-CCP (>3x ULN)
 

0

2

3

C. Acute phase reactants

  • Normal CRP and normal ESR
  • Abnormal CRP and abnormal ESR
 

0

1

D. Duration of symptoms

  • <6 wks.
  • ≥6 wks.
 

0

1

  • Arthritis Rheum 2010; 62:2569-2581

Also read:

  1. Criteria in GPNotebook
  2. Criteria in NICE
  3. Criteria in Statpearls
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