Assessment Tools
CPOC does not recommend particular assessment tools. These are suggestions based on evidence, guidelines and examples of good practice. Examples of these assessment tools, as used by Trusts in the UK, are available online.
Risk scoring models
• 12 physiological and 6 operative variables
Online calculators available- e.g Risk Prediction in Surgery
• 6 preoperative variables to predict 30 day mortality in non cardiac, non-neurological inpatient surgery.
• No morbidity predictions.
• Newer model can incorporate clinician’s assessment
The 2011 NCEPOD study on perioperative care ('Knowing the Risk', see above) looked at risk and outcome in patients undergoing inpatient surgery. One of the principal recommendations in the report from this study included a need for a way to rapidly and easily identify high risk patients, and in response NCEPOD and SOuRCe created the Surgical Outcome Risk Tool (SORT), a rapid percentage mortality risk estimate for patients who are undergoing non-cardiac, non-neurological inpatient surgery.
Find out more about SORT and access the tool online, or alternatively, you can download the app from the App Store and Google Play.
• Provides 30 day mortality and 14 separate morbidity outcomes. Includes measures of frailty
• Validated in USA
• National Emergency Laparotomy Audit (NELA)
• Carlisle risk calculator – prediction of long term survival in patients with AAA
• Nottingham Hip Fracture Score
Medication use/rationalisation
Evidence-based criteria used to review medications in elderly people.
STOPP = Screening Tool of Older Persons’ potentially inappropriate Prescriptions. This tool aims to reduce potentially inappropriate prescribing and polypharmacy
START = Screening Tool to Alert to Right Treatment can be used to identify potentially appropriate medicines in older people with specific comorbidities
Medications with anticholinergic properties can cause adverse events (eg: confusion, falls, increased mortality) in older people. These calculators can help to highlight when an individual patient’s medications contain high levels of anticholinergic properties.
Online calculators available- e.g ACB Calculator
Frailty
• Simple, quick, global assessment
• Predictive of poorer outcomes
• Simple, longer and more in-depth than CFS. Provides details of components of frailty
• Predictive of poorer outcomes
Nutrition
• 5 step screening tool
• Identifies adults who are malnourished, at risk of malnutrition or obese.
• 4 criteria
• Predicts risk of malnutrition in hospitalised patients
Online calculators available- e.g MD Calc
• local dietitians, NHS digital weight management programme, NHS weight loss plan
Mood
• 14 questions (7 anxiety, 7 depression)
• Simple and quick
• Self administered
• Short and long versions
Self referral or GP referral to NHS talking therapies (IAPT, Improving Access to Psychological Therapies programme)
Social support
• Lubben Social Network Scale 6 (LSNS-6)
• local social worker, formal and voluntary sectors
Functional status screening
• Duke Activity Status Index (DASI)
• Self scored
• 12 variables. Gives score 0-58.2. Scores correlate with anaerobic threshold and peak oxygen consumption. A score of below 34 has been suggested to be associated with poorer outcomes.
• A shorter M-DASI (modified-DASI) with 5 questions has been proposed with similar predictive value for AT>11ml/kg/min and VO2 peak>16 ml/kg/min
Online calculators available- e.g MD Calc
• Self scored
• 22 variables – rating ADLs performed in past few weeks and assistance required to perform them
• Self scored
• 10 variables scored 0-2 (0=unable, 1=need help 2= independent). Final score x 5 to give a score/100. Score less than 61 usually taken to indicate significant dependency
• Self scored
• 3 categories of exercise (strenuous, moderate, light) giving an overall picture of a patient’s typical activity levels
• Self administered
• 4 questionnaires. Long and short version. Looks at activity levels over past 7 days
Functional status - objective assessment
• Considered gold standard assessment of functional capacity
• Not dependent on patient motivation
• Requires staff and equipment resources
• Measures distanced walked along flat corridor, Turing around cones at each end at normal pace in 6 minutes.
• Distance walked correlates with peak VO2
• Desaturation of >3% suggests impaired gas exchange
Online videos on how to perform these tests are available
• Predictive of adverse postoperative outcomes
• Correlates to AT and VO2 max
Online videos on how to perform these tests are available
• Distance walked correlates with peak VO2.
• More difficult to administer than 6MWT
• More dependant on patient motivation that 6MWT or CPET
Online videos on how to perform these tests are available
• Desaturation of >3% suggests impaired gas exchange
Online videos on how to perform these tests are available
Cognition
• Simple, quick
• Delirium and cognitive impairment screen
• Simple
• Culturally specific
• Limited validity data
• Included in Nottingham Hip Fracture Score
• 3 word recall and clock face drawing
• Lower score associated with increased risk of delirium, longer hospital stay and lower likelihood of discharge to home environment
• 30 Questions
• Approx. 10 minutes to administer
• Sensitive to mild cognitive impairment/early-stage dementia
• 30 Questions
• Approx 10 minutes to administer
Life expectancy calculators
CPOC does not support or endorse any of the mentioned assessment tools, CPOC is simply providing links to these resources.
