title: Anticipating pulmonary complications after thoracotomy: the FLAM Score.
abstract: OBJECTIVE
  Pulmonary complications after thoracotomy are the result of progressive changes in the respiratory status of the patient. A multifactorial score (FLAM score) was developed to identify postoperatively patients at higher risk for pulmonary complications at least 24 hours before the clinical diagnosis.
  
  
  METHODS
  The FLAM score, created in 2002, is based on 7 parameters (dyspnea, chest X-ray, delivered oxygen, auscultation, cough, quality and quantity of bronchial secretions). To validate the FLAM score, we prospectively calculated scores during the first postoperative week in 300 consecutive patients submitted to posterolateral thoracotomy.
  
  
  RESULTS
  During the study, 60 patients (20%) developed pulmonary complications during the postoperative period. The FLAM score progressively increased in complicated patients until the fourth postoperative day (mean 13.5 +/- 11.9). FLAM scores in patients with complications were significantly higher (p < 0.05) at least 24 hours before the clinical diagnosis of complication, compared to FLAM scores in uncomplicated patients. ROC curves analysis showed that the cut-off value of FLAM with the best sensitivity and specificity for pulmonary complications was 9 (area under the curve 0.97). Based on the highest FLAM scores recorded, 4 risk classes were identified with increasing incidence of pulmonary complications and mortality.
  
  
  CONCLUSIONS
  Changes in FLAM score were evident at least 24 hours before the clinical diagnosis of pulmonary complications.FLAM score can be used to categorize patients according to risk of respiratory morbidity and mortality and could be a useful tool in the postoperative management of patients undergoing thoracotomy.
authors.affiliation: Thoracic Surgery Department, Nice University Hospital, Nice, France. francesco.leo@ieo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Venissac
authors.forename: Daniel
authors.initials: D
authors.lastname: Pop
authors.forename: Marylene
authors.initials: M
authors.lastname: Anziani
authors.forename: Maria E
authors.initials: ME
authors.lastname: Leon
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D013908:Thoracotomy / Q000009:adverse effects*; D055815:Young Adult