Pleural service clinical proforma

Suspected Malignant Pleural Effusion Referral

Digital Proforma & RED Score Calculator

Patient details

HospitalHospital numberNHS numberAgeDate of assessmentReferring clinician

LocationPleural clinicWardOther

Referral details / Clinical history

Section 1: Pre-test probability of malignancy

Clinical features (tick if present)Current smoker or ex-smokerKnown malignancyAsbestos exposureUnintentional weight loss and/or systemic symptoms

Radiological features (CT or thoracic ultrasound)Pleural nodularityPleural thickening >10 mmPleural-based massDiaphragmatic pleural involvementMediastinal pleural involvementChest wall invasion

Sections 2–4: Clinical & ultrasound parameters

Dyspnoea VAS score (0–10 cm)Question to patient:“On average, how breathless have you felt in the last 24 hours?”

No breathlessness at all

012345678910

Worst possible breathlessness0.0

Respiratory rate (breaths/min)

Maximum pleural effusion depth (cm)Measured from visceral to parietal pleura using ultrasound.

Ultrasound measurement guide Ultrasound image demonstrating measurement of pleural effusion depth

Oxygen therapy

RED Score result

Awaiting inputs

Total score0.0

Recurrence risk

Enter dyspnoea VAS, respiratory rate and effusion depth to calculate the result.

Note: RED (Recurrence, Effusion, Dyspnoea) score is used in known or suspected malignant pleural effusion to estimate timing of recurrence. This calculator follows the scoring logic supplied with this proforma and does not replace clinical judgement.

Section 7: WHO / ECOG performance status

Select performance status0Fully active1Restricted activity2Self-care OK3Limited self-care4Disabled5Dead

Section 8: Management decision

Therapeutic aspirationChest drain insertionReferral for definitive pleural intervention

●Patient details

✓Section 1: Pre-test probability of malignancy