Detsky Modified Cardiac Risk Index Calculator

How does this Detsky modified cardiac risk index calculator work?

This health tool determines the degree of cardiovascular risk in the periopeative setting for patients which present cardiac risk factors. This is based on the modified version of the Detsky cardiac risk score and consists of 9 potential heart risk factors.

■ Age – as usual cardiovascular risk factor.

■ Prior myocardial infarction – in personal history and delineated if in the past 6 months or long ago.

■ Unstable angina in the last 6 months – personal history diagnosis present.

■ Angina pectoris – the weight awarded to this item depends on the angina class as per the Canadian Cardiovascular Society Angina classification.

■ Alveolar pulmonary edema – present at the moment of assessment or in patient history.

■ Suspected critical aortic stenosis – as sign of atheriosclerosis or coronary artery disease.

■ Arrhythmia – any rhythm dysfunctionalities with chances of sinus rhythm or more than 5 premature ventricular beats.

■ Emergency surgery – whether the surgery is in emergency or elective, regardless of it being classed as major or minor.

■ General medical status – simplified by saying whether it is normal or poor. This is left for the medical specialist doing the assessment to decide.

The modified version added a slightly different interpretation and some new variables to the original score, i.e. angina and pulmonary edema. The risk stratification has also changed to feature three risk groups: low, moderate and high and modified the point allocation.

The predictive information in the Detsky modified cardiac risk index calculator addresses patients who are to undergo minor or major noncardiac surgery. Examples of what classes as major noncardiac surgery include vascular, head and neck, orthopedic, intra-thoracic and intraperitoneal. Examples of minor surgery include cataract or prostate procedures.

There is also available a guide from the American College of Cardiology (ACC) and the American Heart Association (AHA) which establishes preoperative cardiovascular evaluation.

Compared to elective surgery, emergency surgery is considered a higher risk procedure associated with large fluid shifts and blood loss.

Clinical predictors or perioperative cardiac risk

According to most studies in the area of perioperative risk, the three risk groups are characterized by the following risk factors:

■ Major risk factors include recent myocardial infarction, severe unstable angina, decompensated CHF, AV block arrhythmias or severe valvular disease.

■ Moderate risk factors are mild angina, prior MI, compensated or prior chronic heart failure, diabetes mellitus and renal insufficiency.

■ Low risk factors are evidence of abnormal ECG, abnormal rhythm, history of stroke, uncompensated hypertension, advanced age and poor functional scoring.

Score interpretation

Each of the nine items in the modified Detsky score include answer choices which are awarded a different number of points, depending on the gravity imposed by the presence of that item in the overall diagnosis. The three risk groups dependant on the sum of the answer points are:

■ >30: High risk;

■ 16 – 30: Moderate risk;

■ <16: Low risk.

References

1) Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, Scott JG, Forbath N, Hilliard JR. (1986) Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med; 1(4):211-9.

2) Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. (1986) Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med; 146(11):2131-4.

3) Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O'Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. (1977) Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med; 297(16):845-50.