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

•    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 
 

Find out more here

•    Provides 30 day mortality and 14 separate morbidity outcomes. Includes measures of frailty 
•    Validated in USA
 

View here

•    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
 

Find out more here (p17-p20)

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.

Find out more here

Online calculators available

Frailty

•    Simple, quick, global assessment 
•    Predictive of poorer outcomes

Please find the CFS here
 

•    Simple, longer and more in-depth than CFS. Provides details of components of frailty
•    Predictive of poorer outcomes

View the tool here

Nutrition

•    5 step screening tool
•    Identifies adults who are malnourished, at risk of malnutrition or obese.

View here

•    4 criteria 
•    Predicts risk of malnutrition in hospitalised patients

Online calculators available

•  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

•    Self scored
•   22 variables – rating ADLs performed in past few weeks and assistance required to perform them

View the tool here

•    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

Find out more here

•   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 function 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
 

Find out more here

•    Simple
•    Culturally specific
•    Limited validity data
•    Included in Nottingham Hip Fracture Score
 

Information can be found here

•    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
 

Find out more here

•    30 Questions
•    Approx. 10 minutes to administer
•    Sensitive to mild cognitive impairment/early-stage dementia
 

•    30 Questions
•    Approx 10 minutes to administer
 

Find out more here

CPOC does not support or endorse any of the mentioned assessment tools, CPOC is simply providing links to these resources.