| Aldrete's scoring system | |
| Purpose: | Determining when patients can be safely discharged from the post-anesthesia care unit. |
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, a Mexican anesthesiologist, while working at the Denver Veterans Affairs Hospital.
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 | Modified by author in 1995 | Additional criteria by Marshall and Chung 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 \pm BP \pm BP \pm | Sometimes heart rate is included (but was not in the author's second paper)Heart rate \pm Heart rate \pm Heart rate \pm Patients \pm These additional points change the overall target score. | BP \pm \pm BP \pm | |
| 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." | ||
The following criteria also exist:[4]