Updated Review of the Burch-Wartofsky Score

The Burch-Wartofsky Point Scale (BWPS) is a clinical scoring tool introduced in 1993 to assess the likelihood of thyroid storm in patients with thyrotoxicosis. It assigns points for thermoregulatory dysfunction (fever), central nervous system effects, gastrointestinal-hepatic dysfunction, cardiovascular dysfunction (tachycardia, atrial fibrillation, heart failure), and the presence of a precipitating event. The total score ≥45 is highly suggestive of thyroid storm requiring ICU admission and aggressive multi-modal therapy; 25–44 indicates impending storm warranting close monitoring and treatment; and <25 makes thyroid storm unlikely, shifting focus to identifying and managing the underlying cause of thyrotoxicosis.