THE PREDICTIVE VALUE OF THE BURCH-WARTOFSKY POINT SCALE (BWPS) IN CLINICALLY DIAGNOSING THYROID STORM

Abstract

INTRODUCTION
Thyroid Storm (TS) is a life-threatening manifestation of thyrotoxicosis. The current method for diagnostic classification includes using the Burch-Wartofsky Point Scale (BWPS). A BWPS score of 45 or more is highly suggestive of TS, between 25 to 44 indicative of impending TS, and less than 25 unlikely TS. Our objectives were to evaluate the predictive value of BWPS in a group of patients clinically diagnosed as TS, impending TS or compensated thyrotoxicosis (CT).

METHODOLOGY
This was a retrospective study of adult hospitalized patients in Hospital Tengku Ampuan Afzan (HTAA) during a one-year period (March 2018 to March 2019), clinically diagnosed as TS.

RESULTS
Of 20 thyrotoxic patients, 4 were clinically diagnosed as TS, 5 as impending TS and the remaining 11 as thyrotoxicosis. Among the 4 clinically treated as TS, 3 were later biochemically proven as TS, with BWPS score of 60, 85 and 65, respectively. The remaining patient had a BWPS score of 50 but thyroid function test (TFT) results later confirmed  otherwise. The 5 patients diagnosed as impending TS were all later confirmed as compensated thyrotoxicosis (CT). All 11 patients diagnosed as thyrotoxicosis did not have biochemical evidence of TS in their TFT results. Among the components of BWPS, the rates for fever, tachycardia and altered mentation contributed the highest scores for clinically diagnosing TS. Using the BWPS, the positive predictive value (PPV) and negative predictive value (NPV) of diagnosing TS was 75% and 100%, respectively.

CONCLUSION
The BWPS is a good diagnostic and predictive tool for clinically evaluating TS, thus allowing administration of prompt treatment.