Aldrete's scoring system

The Aldrete’s scoring system is a commonly used scale for determining when people can be safely discharged from the post-anesthesia care unit (PACU) to either the postsurgical ward or to the second stage (Phase II) recovery area.[1][2]

Aldrete's scoring system
Purpose	Determining when people can be safely discharged from the post-anesthesia care unit

The Aldrete Scoring System was devised in 1970[1][3] by Jorge Antonio Aldrete, a Mexican anesthesiologist, while working at the Denver's Veterans Affairs Hospital. In 1988, he developed the famous anesthetic delivery system to be used in major operating theaters world wide, the Combined Spinal Epidural Anesthesia and 1989 he established a well-known pain management clinic in Florida. By 1999, he founded the non-profit organization, the Arachnoiditis Foundation Incorporated. He currently practices and lives in Miami, Florida.[4]

The modified Aldrete Scoring System uses SpO₂ instead of Colour. This scoring system was assessed by Wiley et al. 2002 to assess its effectiveness.

Scoring system

The original score is presented here alongside a modified version (The original score was before the invention of pulse oximetry):

	Original 1970 version[3]	Modified by author in 1995[1]	Additional criteria by Marshall and Chang in 1999 for ambulatory surgery[5]
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 ${\displaystyle \pm }$20% of pre-anaesthetic level (2 Points) BP ${\displaystyle \pm }$20-49% of pre-anaesthetic level (1 Point) BP ${\displaystyle \pm }$50% of pre-anaesthetic level (0 Points)	Sometimes heart rate is included (but was not in the author's second paper) Heart rate ${\displaystyle \pm }$20bpm pre-anaethetic level (2 points) Heart rate ${\displaystyle \pm }$20-35bpm pre-anaesthetic level Heart rate ${\displaystyle \pm }$35-50bpm pre-anaesthetic level Patients ${\displaystyle \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 ${\displaystyle \pm }$20% of pre-anaesthetic level (2 Points) BP ${\displaystyle \pm }$20-40% of pre-anaesthetic level (1 Point) BP ${\displaystyle \pm }$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

Most departments have a minimum criterion in each category but this is not in the original scoring system. No time limit is dictated in the original paper. Some limitations in this scoring system come from premorbid conditions. Activity (limb movement) will be affected by regional or caudal anaesthesia. Temperature, urine output, oral intake, blood results and psychomotor testing are not included.

Alternatives

The following criteria also exist:[6]

• 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.[7] 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, JA (February 1995). "The post-anesthesia recovery score revisited". Journal of Clinical Anesthesia. 7 (1): 89–91. doi:10.1016/0952-8180(94)00001-k. PMID 7772368.
2. White, Paul F. (1999). "New Criteria for Fast-Tracking After Outpatient Anesthesia: A Comparison with the Modified Aldrete's Scoring System" (PDF). Anesthesia and Analgesia. International Anesthesia Research Society. Archived from the original (PDF) on 31 March 2017. Retrieved 15 July 2015.
3. Aldrete, J. A.; Kroulik, D. (1970-11-01). "A postanesthetic recovery score". Anesthesia and Analgesia. 49 (6): 924–934. doi:10.1213/00000539-197011000-00020. ISSN 0003-2999. PMID 5534693.
4. de:Jorge Antonio Aldrete
5. 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.
6. 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.
7. 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.