Gupta et al developed an index for predicting certain complications in a patient undergoing carotid endarterectomy (CEA). This can help to identify a patient who may require more aggressive management. The authors are from the University of Wisconsin, Creighton University and William S. Middleton Memorial Veterans Hospital.
Patient selection: asymptomatic candidate (related to cerebral ischemia) for elective carotid endarterectomy (CEA)
Outcome: perioperative stroke, myocardial infarction or death
Basis: Guidelines recommend CEA only if perioperative risk for stroke, myocardial infarction or death is less than 3%.
Parameters:
(1) age in years
(2) dyspnea at rest or after moderate exertion
(3) history of peripheral revascularizaton procedure or amputation
(4) COPD
(5) angina in the 30 days prior to surgery
(6) dependent functional status in the 30 days prior to surgery
|
Parameter |
Finding |
Points |
|
age in years |
< 60 years of age |
0 |
|
|
60 to 69 years |
-1 |
|
|
70 to 79 years |
-1 |
|
|
>= 80 years |
2 |
|
dyspnea |
no |
0 |
|
|
yes |
2 |
|
revascularization or amputation |
no |
0 |
|
|
yes |
3 |
|
COPD |
no |
0 |
|
|
yes |
3 |
|
angina in past month |
no |
0 |
|
|
yes |
4 |
|
dependent functional status |
no |
0 |
|
|
yes |
5 |
where:
• An age of 60 to 69 is scored as –1 in Table 3 and +1 in the text.
• Dyspnea after mild exertion would also be included.
• COPD was defined as emphysema or chronic bronchitis with one or more of the following: functional disability, past hospitalization for COPD, chronic bronchodilator therapy or FEV1 < 75% of predicted.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -1
• maximum score: 19
• The higher the score the greater the risk.
|
Score |
Risk |
|
-1 to 3 |
1.2 to 2.6% |
|
4 to 7 |
3.1 to 5.6% |
|
8 to 10 |
6.8 to 9.8%% |
|
11 to 13 |
11.7 to 16.5% |
|
14 to 16 |
19.4 to 26.4% |
|
17 to 19 |
30.5 to 39.5% |
If the data in Table IV is analyzed:
|
Score |
Risk |
|
-1 to 8 |
(0.05568 * ((score)^2)) + (0.2133 * (score)) + 1.422 |
|
8 to 19 |
(0.1807 * ((score)^2)) - (1.894 * (score)) + 10.53 |
Specialty: Neurology
ICD-10: ,
