Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the
post-anesthesia care unit
A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery, is a vital part of hospitals, ambulatory care centers, and other medical facilities. Patients who received gener ...
(PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. It was devised in 1970
by , a Mexican
anesthesiologist
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
, while working at the Denver Veterans Affairs Hospital.
Scoring system
The original scoring system was developed before the invention of
pulse oximetry
Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of ...
and used the patient's colouration as a surrogate marker of their oxygenation status. A modified Aldrete scoring system was described in 1995
which replaces the assessment of skin colouration with the use of pulse oximetry to measure SpO
2.
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
Caudal anaesthesia (or caudal anesthesia), is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus.
It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeri ...
. Temperature, urine output, oral intake, blood results and psychomotor testing are not included.
Alternatives
The following criteria also exist:
* 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.
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
{{Reflist
Anesthesia
Medical scoring system