The Eagle score is one of the tests commonly used by diagnosticians for determining mortality risks in cardiovascular patients prior to surgery. Physicians use the five-point medical scoring system combined with the Detsky and Goldman tests, which take into account categories that include patient age, cardiac status, laboratory values, and other medical conditions. The evaluations provide an assessment of patient risk level. Health care providers also use dipyridamole/thallium scanning to provide a visual study of the heart and blood vessels.
There are five categories used to determine an Eagle score. The first three are whether the patient is older than 70, experiences angina, and has diabetes. The fourth is whether the patient exhibits a certain type of Q waves on an electrocardiogram; this can indicate dead muscle tissue, a sign of a previous heart attack. A diagnosis of ventricular dysrhythmia, a type of heart rhythm disturbance, is the fifth category. Some Eagle score assessments also ask if the patient has congestive heart failure or a history of myocardial infarction — also called a heart attack.
The suspected mortality rate for patients who do not fit any of the categories is generally 3%. The rate increases to 8% in patients who occupy one or two categories and rises substantially to 18% for those falling into three categories. The Eagle score assessment is typically shown alongside Detsky and Goldman scores, which are other cardiac risk indices with slightly different categories, in different columns on the same form.
A written survey assigns specific numbers, in the Detsky and Goldman columns, for each of the risk categories each index considers. A Detsky score of greater than 15, combined with a Goldman score of more than 12, falling into more than three categories on the Eagle score, typically indicates that a patient is a high-risk surgical candidate. Low scores on the Detsky and Goldman tests and no Eagle score generally indicate a patient who is a lower surgical risk.
Six different categories are typically considered when looking at a patient's cardiac risk, combining questions from the Eagle score with Detsky and Goldman portions of the test. The first includes patient history, patient age, history of myocardial infarction, and the possibility of pulmonary edema, which is the build-up of fluid in the lungs. An angina category assesses whether the condition is stable.
The cardiac exam determines whether patients have congestive heart failure or aortic stenosis, a condition in which the valve that controls the flow of blood out of the heart does not open completely. The electrocardiogram category indicates the presence of specific dysrhythmias. A general medical condition category is based on laboratory values that include blood gases, blood urea nitrogen (BUN), creatinine levels, and the underlying medical diagnosis. The final category indicates the type of surgery required by the patient.
Physicians do not generally rely on the written survey alone, but also perform a dipyridamole-thallium study. This scanning procedure evaluates the cardiovascular system while the system experiences chemical stress. Physicians administer a vasoconstrictor, dipyridamole, to narrow the blood vessels, along with a radioactive substance, thallium, and track the condition of blood vessels and the heart. This test either disproves or further verifies the results obtained from the written Eagle score-Detsky-Goldman assessment survey.
