Infective Endocarditis Diagnosis (Modified Duke) — free guideline decision tool
The modified Duke (and 2023 Duke-ISCVID) criteria classify infective endocarditis as definite, possible, or rejected using major and minor criteria.
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Implements the decision logic from published clinical guidelines.
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No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) | No |
|---|---|
| Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) | No |
| Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) | No |
| Minor · fever ≥ 38℃ | No |
| Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) | No |
| Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) | No |
| Minor · microbiologic evidence (not meeting a major criterion) | No |
→Duke determinationRejected (needs exclusion/reassessment)
- Count：Major criteria 0, minor criteria 0 → Rejected (needs exclusion/reassessment)
- Decision rule：Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected
- Management direction：Assess other causes of fever/bacteremia
| Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) | Met |
|---|---|
| Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) | Met |
| Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) | Met |
| Minor · fever ≥ 38℃ | Met |
| Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) | Met |
| Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) | Met |
| Minor · microbiologic evidence (not meeting a major criterion) | Met |
→Duke determinationDefinite IE (clinical criteria)
- Count：Major criteria 2, minor criteria 5 → Definite IE (clinical criteria)
- Decision rule：Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected
- Management direction：Management follows current guidelines and local protocols; this page gives no management recommendation.
Common questions
What is Infective Endocarditis Diagnosis (Modified Duke)?
The modified Duke (and 2023 Duke-ISCVID) criteria classify infective endocarditis as definite, possible, or rejected using major and minor criteria.
How is Infective Endocarditis Diagnosis (Modified Duke) calculated? What is the core formula?
Definite = 2 major, or 1 major + 3 minor, or 5 minor; possible = 1 major + 1 minor, or 3 minor; otherwise rejected. Major = typical microbiology or imaging evidence; minor = predisposition, fever, vascular/immunologic phenomena, supporting microbiology.
When is Infective Endocarditis Diagnosis (Modified Duke) used?
Management follows current guidelines and local protocols; this page gives no management recommendation.
What are the key clinical points for Infective Endocarditis Diagnosis (Modified Duke)?
A negative transthoracic echo with high clinical suspicion warrants a transesophageal echo before rejecting the diagnosis (original synthesis · not guideline verbatim). The 2023 Duke-ISCVID revision adds cardiac CT, intraoperative findings, and PET/CT and broadens predisposition to CIED/TAVR/prior IE. Pathologic criteria (organism in vegetation/valve tissue) confirm directly and override the clinical count.
What are the limits and cautions when using Infective Endocarditis Diagnosis (Modified Duke)?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
Does Infective Endocarditis Diagnosis (Modified Duke) upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
How is Infective Endocarditis Diagnosis (Modified Duke) calculated in practice? Can you show a worked example?
Inputs: Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) No, Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) No, Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) No, Minor · fever ≥ 38℃ No, Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) No, Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) No, Minor · microbiologic evidence (not meeting a major criterion) No → Result: Duke determination Rejected (needs exclusion/reassessment)（Count: Major criteria 0, minor criteria 0 → Rejected (needs exclusion/reassessment), Decision rule: Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected, Management direction: Assess other causes of fever/bacteremia） Inputs: Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) Met, Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) Met, Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) Met, Minor · fever ≥ 38℃ Met, Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) Met, Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) Met, Minor · microbiologic evidence (not meeting a major criterion) Met → Result: Duke determination Definite IE (clinical criteria)（Count: Major criteria 2, minor criteria 5 → Definite IE (clinical criteria), Decision rule: Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected, Management direction: Management follows current guidelines and local protocols; this page gives no management recommendation.）
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The modified Duke (and 2023 Duke-ISCVID) criteria classify infective endocarditis as definite, possible, or rejected using major and minor criteria.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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