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Overview :
The Cardiac Anesthesia Risk Evaluation Scale (CARE Score) is
a simple risk classification system for patients undergoing cardiac surgery.
This can rapidly stratify a patient for the probability of morbidity and
mortality. The authors are from the University of Ottawa Heart Institute in
Canada.
Parameters:
(1) cardiac disease status
(2) medical disease status
(3) cardiac surgery planned
(4) urgency of surgery
|
Parameter |
Status |
Group |
|
cardiac disease |
stable |
A1 |
|
|
uncontrolled |
A2 |
|
|
advanced (end stage) |
A3 |
|
medical diseases |
none |
B1 |
|
|
1 or more controlled |
B2 |
|
|
1 or more uncontrolled |
B3 |
|
cardiac surgery |
noncomplex |
C1 |
|
|
complex |
C2 |
|
|
undertaken as last hope to save or improve life |
C3 |
|
urgency of surgery |
not emergency |
D1 |
|
|
emergency (surgery performed as soon as diagnosis is
made and an OR is available) |
D2 |
Controlled medical problems include:
• controlled hypertension
• controlled diabetes mellitus
• controlled peripheral vascular disease
• controlled chronic obstructive pulmonary disease
• controlled systemic disease
Uncontrolled cardiac or medical problems include:
• unstable angina pectoris treated with intravenous heparin
or nitroglycerin
• preoperative intra-aortic balloon pump
• heart failure with pulmonary or peripheral edema
• uncontrolled hypertension
• renal insufficiency (serum creatinine > 140µmol/L
• other debilitating systemic disease
Complex surgery includes:
• reoperation
• combined valve and coronary artery surgery
• multiple valve surgery
• left ventricular aneurysmectomy
• repair of ventricular septal defect (VSD) after myocardial
infarction
• coronary artery bypass of diffuse or heavily calcified
vessels
|
Situation |
Score |
Risk
Category |
|
A1 AND B1 AND C1 |
1 |
1 |
|
A1 AND B2 AND C1 |
2 |
2 |
|
(A2 OR B3 OR C2) AND D1 |
3 |
3 |
|
(A2 OR B3 OR C2) AND D2 |
3E |
4 |
|
(A2 OR A3 OR B3) AND C2 AND D1 |
4 |
5 |
|
(A2 OR A3 OR B3) AND C2 AND D2 |
4E |
6 |
|
A3 AND C3 AND D1 |
5 |
7 |
|
A3 AND C3 AND D2 |
5E |
8 |
|
Risk Category |
Morbidity |
Prolonged Length of
Stay |
Mortality |
|
1 |
5.4%
(4.3-6.8) |
2.9%
(2.2-3.9) |
0.5%
(0.3-0.9) |
|
2 |
10.3%
(8.9-12.1) |
5.1%
(4.2-6.3) |
1.1%
(0.7-1.7) |
|
3 |
19%
(17.2-20.9) |
8.8%
(7.6-10.2) |
2.2%
(1.6-3.1) |
|
4 |
32.1%
(29.3-35.0) |
14.7%
(12.8-16.8) |
4.5%
(3.5-5.7) |
|
5 |
48.8%
(44.1-53.6) |
23.5%
(20.1-27.3) |
8.8%
(6.9-11.3) |
|
6 |
65.8%
(59.5-71.6) |
35.4%
(29.3-42.0) |
16.7%
(12.4-22.1) |
|
7 |
79.6%
(73.2-84.7) |
49.4%
(40.4-58.5) |
29.3%
(20.8-39.6) |
|
8 |
88.7%
(83.5-92.5) |
63.6%
(52.5-73.4) |
46.2%
(32.4-60.5) |
after Table 4, page 200
Performance:
• predicted
morbidity Area Under Curve by ROC Analysis: 0.721 +/- 0.014
• predicted
mortality Area Under Curve by ROC Analysis: 0.801 +/- 0.027
• These
values compared favorably to the Parsonnet, Tu and Truman scores (see Chapter 6
on Cardiology).
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