[Scoring system for early detection of critical illness can fail]

A 57-year old male underwent elective aortic valve replacement. The immediate post-operative course was uneventful and the patient was discharged with the lowest possible score on a newly implemented scale for early detection of critical illness. The following day he was readmitted with dyspnoea. The critical illness score was still low despite ultrasonic demonstration of a large pericardial effusion requiring drainage. We are concerned that the widely adopted critical illness scale is not sufficiently sensitive for cardiac surgery patients and advocate the use of point-of-care ultrasound.