Sgarbossa Criteria
Identifies acute MI in patients with left bundle branch block or ventricular paced rhythm
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Care settings
- Emergency department, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The Sgarbossa Criteria can activate when the transcript or pasted chart context documents any of these:
- Chest pain with LBBB on ECG
- STEMI criteria in LBBB
- Acute MI with ventricular pacing
- New LBBB with chest pain
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I21.
Note-type scope: it activates on notes whose subject resolves to cardiology, emergency medicine, critical care, hospital medicine. 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
3 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 |
|---|---|---|---|
| Concordant ST elevation ≥1mm in leads with positive QRS | exam | ||
| Concordant ST depression ≥1mm in V1-V3 | exam | ||
| Discordant ST elevation ≥5mm (or Smith-modified: ST/S ratio >0.25) | exam |
Scoring
Concordant ST elevation ≥1mm (+5), Concordant ST depression ≥1mm in V1-V3 (+3), Discordant ST elevation ≥5mm (+2). Score ≥3 is highly specific for MI. Smith-modified: replace discordant criterion with ST/S ratio >0.25.
5×Concordant STE Concordant ST elevation ≥1mm in leads with positive QRS + 3×Concordant STD V1-V3 Concordant ST depression ≥1mm in V1-V3 + 2×Discordant STE≥5mm Discordant ST elevation ≥5mm (or Smith-modified: ST/S ratio >0.25)
Interpretation
Score ≥3: Highly specific for acute MI in LBBB (specificity 90%). Concordant ST elevation alone (5 pts) is most specific criterion. Smith-modified criteria improve sensitivity with ST/S ratio >0.25 replacing the discordant criterion.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Sgarbossa EB et al. 1996.
- Sgarbossa EB et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch blockSgarbossa et al. 1996 · 1996 · GUSTO-1 · Level I · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Sgarbossa 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. A stated Sgarbossa Criteria value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a mandatory rule-out score: a missed result carries acute harm, so the activation filter never approves it on uncertainty.
See it activate on your own encounter
14 days of full Pro. No sales call.
14-day Pro trial, no credit card required. Everything in Pro, including Rounding, for up to 150 notes. To keep Pro after day 14, subscribe for $79/month plus applicable tax. If you don't, nothing is charged and your account becomes read-only, with every note kept.