Aggregate Prolonged Air Leak (PAL) Score of Brunelli et al for a Patient Undergoing Lobectomy

Description

Brunelli et al developed the Aggregate Prolonged Air Leak (PAL) Score to evaluate a patient undergoing a pulmonary lobectomy. This can help to identify a patient who may have a prlonged air leak. The authors are from Ospedali Riuniti in Ancona, Italy, and Salamanca University Hospital in Spain.

Patient selection: lobectomy

Outcome: prolonged air leak (lasting > 5 days)

Parameters:

(1) age in years

(2) body mass index (BMI)

(3) FEV1 as percent of predicted ("perioperative", not stated as pre or post. After lobectomy there should be a significant drop. In the implementation pre-operative FEV1 will be used)

(4) dense pleural adhesions seen at surgery (cover an entire lobe or >= 30% of lung surfaces)

Parameter	Finding	Points
age in years	<= 65 years of age	0
	> 65 years of age	1
BMI	>= 25.5 kg per sq meter	0
	< 25.5 kg per square meter	2
FEV1	>= 80% of predicted	0
	< 80% of predicted	1.5
dense pleural adhesions	absent	0
	present	1

total score =

= SUM(points for all 4 parameters)

Interpretation:

• minimum score: 0

• maximum score: 5.5

• The higher the score the greater the risk of prolonged air leak.

Score	Class	Prolonged Air Leak
0	A	< 1.5%
1	B	5-7%
1.5 to 3	C	11-13%
3.5 to 5.5	D	26-29%

Performance:

• Area under the ROC curve (C-statistic) 0.69-0.71.

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Description

Specialty

ICD-10