Predictive Performance and Variability of the Cardiac Anesthesia Risk Evaluation Score

BACKGROUND: The Cardiac Anesthesia Risk Evaluation (CARE) score, a simple Canadian classification for predicting outcome after cardiac surgery, was evaluated in 556 consecutive patients in Paris, France. The authors compared its performance to those of two multifactorial risk indexes (European System for Cardiac Operative Risk Evaluation [EuroSCORE] and Tu score) and tested its variability between groups of physicians (anesthesiologists, surgeons, and cardiologists). METHODS: Each patient was simultaneously assessed using the three scores by an attending anesthesiologist in the immediate preoperative period. In a blinded study, the CARE score category was also determined by a cardiologist the day before surgery, by a surgeon in the operating room, and by a second anesthesiologist at arrival in intensive care unit. Calibration and discrimination for predicting outcomes were assessed by goodness-of-fit test and area under the receiver operating characteristic curve, respectively. The level of agreement of the CARE scoring between the three physicians was then assessed. RESULTS: The calibration analysis revealed no significant difference between expected and observed outcomes for the three classifications. The areas under the receiver operating characteristic curves for mortality were 0.77 with the CARE score, 0.78 with the EuroSCORE, and 0.73 with the Tu score (not significant). The agreement rate of the CARE scoring between two anesthesiologists, between anesthesiologists and surgeons, and between anesthesiologists and cardiologists were 90%, 83%, and 77%, respectively. CONCLUSIONS: Despite its simplicity, the CARE score predicts mortality and major morbidity as well the EuroSCORE. In addition, it remains devoid of significant variability when used by groups of physicians of different specialties.