CART (Cardiac Arrest Risk Triage) Score

CART Score
Age ≥55 Years
Respiratory Rate ≥25/min
Heart Rate ≥110 bpm
Diastolic BP ≤35 mmHg
Previous ICU Admission This Hospitalization
Abnormal Rhythm on Presentation
CART Score: 0
Very Low Risk
CART Score 0. Very low risk of cardiac arrest. Continue routine monitoring.
Predicts risk of in-hospital cardiac arrest.

Why Use

Predicting deterioration in ward patients may be difficult. Validated risk scores such as CART may help. Outperformed MEWS at predicting cardiac arrest in one study (AUROC 0.84 vs 0.78) ( Churpek 2013 ).

Formula

Addition of the selected points: Variable Points Respiratory rate, breaths/min <21 0 21-23 8 24-25 12 26-29 15 >29 22 Heart rate, beats/min <110 0 110-139 4 >139 13 Diastolic BP, mmHg >49 0 40-49 4 35-39 6 <35 13 Age, years <55 0 55-69 4 >69 9

Pearls / Pitfalls

A systematic review of early warning system (EWS) scores, including CART, concluded that such scores perform well to predict cardiac arrest but that impact on outcomes and resource utilization is still uncertain, and current evidence is insufficient ( Smith 2014 ). Requires accurate respiratory rate.

Advice

Patients with high CART Scores may benefit from escalation of care. Use clinical judgment in addition to risk stratification scores to make decisions related to disposition.

More Information

Interpretation: CART Score Risk of cardiac arrest within 48 hours ≤20 Low >20 High* *In the original study ( Churpek 2012 ), scores >20 were 91.9% specific for predicting cardiac arrest within 48 hours, and 90% specific in a validation cohort ( Churpek 2013 ).

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