Aldrete's scoring system explained

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.

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 versionModified by author in 1995Additional criteria by Marshall and Chung in 1999 for ambulatory surgery[3]
ActivityAble 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)

RespirationAble to breathe deeply and cough freely (2 Points)Dyspnoea or limited breathing (1 Point)

Apnoeic (0 Points)

Not included
CirculationBP

\pm

20% of pre-anaesthetic level (2 Points)

BP

\pm

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

BP

\pm

50% of pre-anaesthetic level (0 Points)
Sometimes heart rate is included (but was not in the author's second paper)Heart rate

\pm

20bpm pre-anaethetic level (2 points)

Heart rate

\pm

20-35bpm pre-anaesthetic level

Heart rate

\pm

35-50bpm pre-anaesthetic level

Patients

\pm

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

\pm

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

\pm

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

BP

\pm

40% of pre-anaesthetic level (0 Points)
ConsciousnessFully awake (2 Points)Arousable on calling (1 Point)

Not responding (0 Points)

Not included
Colour or O2 SaturationNormal (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
PainMinimal 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 VomitingNone 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."

Alternatives

The following criteria also exist:[4]

Notes and References

  1. Aldrete . J. Antonio . Kroulik . Diane . November 1970 . A Postanesthetic Recovery Score . Anesthesia & Analgesia . en-US . 49 . 6 . 924–934 . 10.1213/00000539-197011000-00020 . 5534693 . 1141517 . 0003-2999.
  2. Aldrete . J. A. . February 1995 . The post-anesthesia recovery score revisited . Journal of Clinical Anesthesia . 7 . 1 . 89–91 . 10.1016/0952-8180(94)00001-k . 0952-8180 . 7772368.
  3. Marshall. S. I.. Chung. F.. 1999-03-01. Discharge criteria and complications after ambulatory surgery. Anesthesia and Analgesia. 88. 3. 508–517. 0003-2999. 10071996. 10.1097/00000539-199903000-00008. free.
  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. 27820558. 10.11124/01938924-201109410-00001. 10536/DRO/DU:30041181. free.
  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. 0003-2999. 10320170. 10.1097/00000539-199905000-00018. free.