MDCalc

VIRSTA Score

Estimates risk of infective endocarditis (IE) and determines priority for echocardiography.

Cerebral or peripheral emboli

Meningitis

Permanent intracardiac device or previous IE

Pre-existing native valve disease

Intravenous drug use

Persistent bacteremia

Vertebral osteomyelitis

Community or non-nosocomial health care associated acquisition

Severe sepsis or shock

C-reactive protein >190 mg/L

Result:

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Advice

This tool is not a replacement for clinical judgment; always correlate results with the patient's clinical presentation and course.

Management
  • High risk (score ≥3): Urgent TEE is indicated to evaluate for infective endocarditis. 
  • Low risk (score <3): 
    • It may be appropriate to forgo TEE. 
    • Continue appropriate management for bacteremia (e.g., antibiotics, source control) and closely monitor for clinical changes.
    • Recalculate the score if complications arise and/or repeat blood cultures are positive.
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