Spetzler-Martin AVM Grading Scale
Grades arteriovenous malformations to predict surgical risk and guide management (surgery vs embolization vs radiosurgery)
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Scoring type
- point sum
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Spetzler-Martin AVM Grading Scale can activate when the transcript or pasted chart context documents any of these:
- AVM evaluation
- Arteriovenous malformation grading
- Neurovascular surgical planning
- AVM treatment decision
- Cerebral AVM risk stratification
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I67.1, Q28.2.
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 |
|---|---|---|---|
| Maximum diameter of AVM nidus (<3cm, 3-6cm, >6cm) | exam | ||
| Whether AVM is in eloquent cortex (sensorimotor, language, visual, thalamus, hypothalamus, brainstem, cerebellar peduncles, deep cerebellar nuclei) | exam | ||
| Presence of deep venous drainage (internal cerebral veins, basal veins, precentral cerebellar vein) | exam |
Scoring
Size: <3cm=1, 3-6cm=2, >6cm=3. Eloquent brain: no=0, yes=1. Deep venous drainage: no=0, yes=1. Total = size + eloquence + venous drainage (range 1-5).
Interpretation
Grade I-II (low): Surgery generally recommended, low morbidity (<5%). Grade III (intermediate): Individualized decision — consider multimodal therapy. Grade IV-V (high): Surgery carries significant risk; consider radiosurgery, embolization, or conservative management. Grade V AVMs have >30% surgical morbidity. Supplementary Lawton-Young grading may refine Grade III decisions.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Spetzler & Martin 1986.
- Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformationsSpetzler & Martin (AVM Grading) 1986 · 1986 · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Spetzler-Martin AVM Grading Scale 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 Spetzler-Martin AVM Grading Scale 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 staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
See it activate on your own encounter
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