Burch-Wartofsky Point Scale (BWPS) for Thyroid Storm

A widely used scoring system to assess the likelihood of thyroid storm in patients with biochemical thyrotoxicosis. Score ranges from 0-140 based on 7 clinical parameters.

Warnings:
  • BWPS is a clinical tool, not a definitive diagnostic test; clinical judgment is essential
  • Thyroid storm is a life-threatening emergency with mortality up to 30% even with treatment
  • Some patients with thyroid storm may score <45; do not exclude diagnosis based on score alone
  • When it is not possible to distinguish intercurrent illness from thyrotoxicosis, points should be assigned to favor storm and empiric therapy initiated
  • Japanese Thyroid Association (JTA) criteria offer an alternative diagnostic framework
  • Pediatric patients require adapted criteria (Adapted Burch-Wartofsky Criteria)
Note: The BWPS was originally described by Burch and Wartofsky in 1993. Total maximum score is 140. Cutoffs: <25 = unlikely, 25-44 = impending, >=45 = highly suggestive of thyroid storm. Concurrent measurement of free T4/T3 supports but does not confirm the diagnosis.
Highest temperature recorded
Heart rate at presentation
Degree of heart failure
Presence of atrial fibrillation
CNS manifestations of thyrotoxicosis
GI/hepatic manifestations
Identifiable precipitating factor

References