# Aldrete's scoring system

Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. It was devised in 1970 by Jorge Antonio Aldrete [de], a Mexican anesthesiologist, while working at the Denver Veterans Affairs Hospital.

## Scoring system

The original scoring system was developed before the invention of pulse oximetry 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$_2$.
| | Original 1970 version | Modified by author in 1995 | Additional criteria by Marshall and Chung in 1999 for ambulatory surgery |
| 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 $\pm$20% of pre-anaesthetic level (2 Points) BP $\pm$20-49% of pre-anaesthetic level (1 Point) BP $\pm$50% of pre-anaesthetic level (0 Points) | Sometimes heart rate is included (but was not in the author's second paper) Heart rate $\pm$20bpm pre-anaethetic level (2 points) Heart rate $\pm$20-35bpm pre-anaesthetic level Heart rate $\pm$35-50bpm pre-anaesthetic level Patients $\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 $\pm$20% of pre-anaesthetic level (2 Points) BP $\pm$20-40% of pre-anaesthetic level (1 Point) BP $\pm$40% of pre-anaesthetic level (0 Points) |
| Consciousness | Fully awake (2 Points) Arousable on calling (1 Point) Not responding (0 Points) | | Not included |
| Colour or O$_2$ Saturation | Normal (2 Points) Pale, dusky, blotchy, jaundiced, or other (1 Point) Cyanotic (0 Points) | Able to maintain SpO$_2$ >92% on room Air (2 Points) Needs supplementary O$_2$ to maintain SpO$_2$ >90% (1 Point) SpO$_2$ <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" | "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." |

## 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.