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Preoperative Prediction Rule of Rudolph et al for Delirium After Cardiac Surgery

Description

Rudolph et al developed a score for predicting the risk of delirium after cardiac surgery based on preoperative findings. This can help to identify a patient who may benefit from more aggressive management. The authors are from VA Boston Healthcare System, Hebrew SeniorLife, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Columbia Presbyterian Medical Center and Harvard Medical Score.


 

Patient selection: adult > 60 years of age prior to cardiac surgery (CABG, valve, both)

 

Parameters:

(1) Mini-Mental State Exam (range from 0 to 30)

(2) Geriatric Depression Scale with 15 items (GDS-15, range from 0 to 15)

(3) serum albumin in g/dL

(4) history of previous stroke or transient ischemic attack (TIA)

Parameter

Finding

Points

mini-mental status

<= 23

2

 

24 to 27

1

 

>= 28

0

GDS-15

<= 4

0

 

> 4

1

serum albumin

> 4.4 g/dL

1

 

3.6 to 4.4 g/dL

0

 

< 3.6 g/dL

1

history of stroke or TIA

no

0

 

yes

1

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maxmum score: 5

• The higher the score the greater the risk of delirum following surgery.

 

Score

Percent Delirium

0

19%

1

47%

2

63%

3 to 5

86%

 

Performance:

• The area under the ROC curve was 0.74.

 


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