Aldrete's scoring system

Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. It was devised in 1970[1] by Jorge Antonio Aldrete, a Mexican anesthesiologist, while working at the Denver Veterans Affairs Hospital.

Aldrete's scoring system
PurposeDetermining when patients can be safely discharged from the post-anesthesia care unit.

Scoring system

The original scoring system was developed before the invention of pulse oximetry and used the patient's colouration as a surrogate marker of their oxygenation status. A modified Aldrete scoring system was described in 1995[2] which replaces the assessment of skin colouration with the use of pulse oximetry to measure SpO2.

Original 1970 version[1] Modified by author in 1995[2] Additional criteria by Marshall and Chang in 1999 for ambulatory surgery[3]
Activity Able to move 4 extremities voluntarily or on command (2 Points)

Able to move 2 extremities voluntarily or on command (1 Point)

Unable to move extremities voluntarily or on command (0 Points)

 Steady gait without dizziness or meets pre-anaethetic level (2 Points)

Requires Assistance (1 Point)

Unable to ambulate (0 Points)

Respiration Able to breathe deeply and cough freely (2 Points)

Dyspnoea or limited breathing (1 Point)

Apnoeic (0 Points)

 Not included
Circulation BP 20% of pre-anaesthetic level (2 Points)

BP 20-49% of pre-anaesthetic level (1 Point)

BP 50% of pre-anaesthetic level (0 Points)

 Sometimes heart rate is included (but was not in the author's second paper)

Heart rate 20bpm pre-anaethetic level (2 points)

Heart rate 20-35bpm pre-anaesthetic level

Heart rate 35-50bpm pre-anaesthetic level

Patients 50bpm or >110bpm or with a change in ECG rhythm must be evaluated by an anaesthesiologist.

These additional points change the overall target score.

 BP 20% of pre-anaesthetic level (2 Points)

BP 20-40% of pre-anaesthetic level (1 Point)

BP 40% of pre-anaesthetic level (0 Points)

Consciousness Fully awake (2 Points)

Arousable on calling (1 Point)

Not responding (0 Points)

 Not included
Colour or O2 Saturation Normal (2 Points)

Pale, dusky, blotchy, jaundiced, or other (1 Point)

Cyanotic (0 Points)

 Able to maintain SpO2 >92% on room Air (2 Points)

Needs supplementary O2 to maintain SpO2 >90% (1 Point)

SpO2 <90% despite supplementary O2 (0 Points)

 Not Included
Pain Minimal to no pain, controllable with oral analgesics (2 Points)

This target not met (1 Point)

Surgical Bleeding (as expected for procedure) Minimal/Does not require dressing change (2 Points)

Moderate/Up to two dressing changes required (1 Point)

Severe/More than three dressing changes required (0 Points)

Nausea and Vomiting None to minimal (2 Points)

Moderate (1 Point)

Severe (0 Points)

Interpretation of score "Score of 9 or greater allows patient to leave Post Anaesthetic Care Unit" "Patients who score 9 or greater and have an appropriate escort can go home."

Limitations

Many institutions caring for surgical patients set minimum Aldrete score thresholds that patients must reach in each category prior to discharge from a PACU, although this use of individual scores was not described in the original scoring system. Additionally, no time limit prior to discharge is dictated in the original paper. The scoring system does not take co-morbid conditions into account for individual patients. Activity (limb movement) scores may be affected by the use of regional or caudal anaesthesia. Temperature, urine output, oral intake, blood results and psychomotor testing are not included.

Alternatives

The following criteria also exist:[4]

  • White in 1999 proposed "fast-track criteria" to determine if patients can be transferred straight from theatre to Phase II recovery. He proposes a minimum overall score of 12 with no score <1 in any category. He includes consciousness, activity, circulation, respiration, oxygen saturations, pain and emesis. This does not include bleeding or urine output.[5] This was used by Song et al. 2004.
  • Post anaesthetic discharge scoring system (PADSS) used by Chung et al. 1995.
  • Discharge criteria tool used by Brown et al. 2008.
  • DASAIM discharge assessment tool used by Gartner et al. 2010.

References
  1. Aldrete, J. Antonio; Kroulik, Diane (November 1970). "A Postanesthetic Recovery Score". Anesthesia & Analgesia. 49 (6): 924–934. doi:10.1213/00000539-197011000-00020. ISSN 0003-2999. PMID 5534693. S2CID 1141517.
  2. Aldrete, J. A. (February 1995). "The post-anesthesia recovery score revisited". Journal of Clinical Anesthesia. 7 (1): 89–91. doi:10.1016/0952-8180(94)00001-k. ISSN 0952-8180. PMID 7772368.
  3. Marshall, S. I.; Chung, F. (1999-03-01). "Discharge criteria and complications after ambulatory surgery". Anesthesia and Analgesia. 88 (3): 508–517. doi:10.1097/00000539-199903000-00008. ISSN 0003-2999. PMID 10071996.
  4. Phillips, Nicole M.; Haesler, Emily; Street, Maryann; Kent, Bridie (2011). "Post-anaesthetic discharge scoring criteria: A systematic review". JBI Library of Systematic Reviews. 9 (41): 1679–1713. doi:10.11124/01938924-201109410-00001. hdl:10536/DRO/DU:30041181. PMID 27820558.
  5. White, P. F.; Song, D. (1999-05-01). "New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system". Anesthesia and Analgesia. 88 (5): 1069–1072. doi:10.1097/00000539-199905000-00018. ISSN 0003-2999. PMID 10320170.
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