What is a BISK Score?
There is no validated clinical scoring system called "BISK" or "Bedside Index of Surgical Risk" in the current medical literature or established guidelines. The term does not appear in any major surgical risk assessment guidelines from the American College of Surgeons, European Society of Cardiology, American Heart Association, or other authoritative sources 1, 2.
Established Surgical Risk Assessment Tools
Since BISK does not exist as a recognized tool, here are the validated risk assessment instruments you should be using instead:
For Cardiac Risk Assessment in Non-Cardiac Surgery
Revised Cardiac Risk Index (RCRI) is the most extensively validated tool recommended by the American Heart Association for initial cardiac risk stratification, using 6 independent predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, renal dysfunction (creatinine >2.0 mg/dL), and high-risk surgery 1, 2.
ACS NSQIP Surgical Risk Calculator is recommended by the American College of Surgeons as the primary comprehensive risk assessment tool, incorporating 21 patient-specific variables and providing procedure-specific risk estimates for multiple outcomes including mortality and major adverse cardiac events 1.
NSQIP MICA (Myocardial Infarction or Cardiac Arrest) calculator may provide superior predictive discrimination compared to RCRI in broader surgical populations, particularly for vascular surgery patients 3, 1.
For Emergency Laparotomy
NELA (National Emergency Laparotomy Audit) risk prediction tool is calibrated specifically for emergency laparotomy and has better calibration for high-risk patients than other common tools 3.
POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator is accurate and user-friendly in predicting 30-day mortality in patients undergoing emergency general surgery 3.
For Frailty Assessment
Risk Analysis Index (RAI) has emerged as the most thoroughly validated and flexible assessment of surgical frailty, proven feasible for bedside screening and effective across a wide variety of clinical contexts 4.
Modified Frailty Index (mFI) calculates risk based on five elements: hypertension, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and functional status, and has demonstrated efficacy across multiple surgical disciplines 5.
Clinical Frailty Scale (CFS9) is a picture-based tool with excellent negative predictive value (95%) when both physician and patient/surrogate provide scores <4, effectively ruling out frailty 6.
For Nutritional Risk
- Nutritional Risk Screening (NRS-2002) is recommended by the European Society for Clinical Nutrition and Metabolism for both elective surgical and critically ill patients, validated to predict postoperative complications and prolonged hospital length of stay 3, 2.
Common Pitfall
Do not confuse non-existent scoring systems with established tools. If you encounter unfamiliar acronyms, verify them against current guidelines before attempting to use them clinically. The proliferation of risk scores can be confusing, but stick to guideline-recommended tools with robust validation 1, 2.