title: Predictive performance and variability of the cardiac anesthesia risk evaluation score.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France. alexandre.ouattara@psl.ap-hop.paris.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
authors.forename: Michaëla
authors.initials: M
authors.lastname: Niculescu
authors.forename: Sarra
authors.initials: S
authors.lastname: Ghazouani
authors.forename: Ario
authors.initials: A
authors.lastname: Babolian
authors.forename: Marc
authors.initials: M
authors.lastname: Landi
authors.forename: Patrick
authors.initials: P
authors.lastname: Lecomte
authors.forename: Gilles
authors.initials: G
authors.lastname: Boccara
authors.forename: Sheida
authors.initials: S
authors.lastname: Varnous
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Pierre
authors.initials: P
authors.lastname: Coriat
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors