Modified Duke Criteria
Classifies likelihood of infective endocarditis based on clinical, microbiological, and echocardiographic findings
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Care settings
- ICU, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The Modified Duke Criteria can activate when the transcript or pasted chart context documents any of these:
- Bacteremia with endocarditis concern
- Persistent positive blood cultures
- New valvular regurgitation
- IVDU with fever
- Prosthetic valve with fever
- Fever of unknown origin with cardiac murmur
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I33.
Note-type scope: it activates on notes whose subject resolves to cardiology, hospital medicine, critical care. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
6 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Blood culture results (organism, number positive) | lab | ||
| Echocardiogram findings (vegetation, abscess, dehiscence) | lab | ||
| Temperature ≥38°C | vital | ||
| Septic emboli, mycotic aneurysm, Janeway lesions, conjunctival hemorrhage | exam | ||
| Glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor | exam | ||
| Predisposing heart condition or IVDU | history |
Scoring
Major: (1) Typical organism from 2 cultures or persistently positive, (2) Endocardial involvement on echo or new regurgitation. Minor: Predisposing condition, fever, vascular phenomena, immunologic phenomena, microbiologic evidence not meeting major. Definite: 2 major OR 1 major + 3 minor OR 5 minor. Possible: 1 major + 1 minor OR 3 minor.
Interpretation
Definite: 2 major, or 1 major + 3 minor, or 5 minor criteria. Possible: 1 major + 1 minor, or 3 minor. Rejected: firm alternative diagnosis, resolution with ≤4 days antibiotics, or no pathologic evidence.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Durack DT et al. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findingsDurack et al. (Duke Criteria) 1994 · 1994 · Duke University · Level I · link last verified 2026-03-23
How Scribeable handles it in the note
When an encounter activates the Modified Duke Criteria at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Modified Duke Criteria value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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