Predictive performance and variability of the cardiac anesthesia risk evaluation score

Area of Science:

• Cardiology
• Anesthesiology
• Health Services Research

Background:

• The Cardiac Anesthesia Risk Evaluation (CARE) score is a Canadian tool for predicting outcomes in cardiac surgery.
• Its performance was compared against the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Tu score in 556 French patients.
• Variability in CARE score application among anesthesiologists, surgeons, and cardiologists was assessed.

Purpose of the Study:

• To evaluate the predictive performance of the CARE score for outcomes after cardiac surgery.
• To compare the CARE score's accuracy with the EuroSCORE and Tu score.
• To assess the inter-physician variability of the CARE score across different medical specialties.

Main Methods:

• Patients were assessed using the CARE score, EuroSCORE, and Tu score by attending anesthesiologists.
• The CARE score was also evaluated by cardiologists, surgeons, and a second anesthesiologist in a blinded manner.
• Calibration and discrimination were assessed using goodness-of-fit tests and receiver operating characteristic curves; inter-physician agreement was also calculated.

Main Results:

• No significant differences in calibration were found between expected and observed outcomes for all three scores.
• Areas under the receiver operating characteristic curves for mortality prediction were similar: CARE score (0.77), EuroSCORE (0.78), and Tu score (0.73).
• Agreement rates for the CARE score were high: 90% between anesthesiologists, 83% between anesthesiologists and surgeons, and 77% between anesthesiologists and cardiologists.

Conclusions:

• The CARE score demonstrates comparable predictive accuracy for mortality and major morbidity to the EuroSCORE, despite its simplicity.
• The CARE score exhibits low variability when applied by physicians from different specialties, suggesting its robustness in clinical practice.