New issues in severity scoring: interfacing the ICU and evaluating it

Abstract

Since the development of the first general outcome prediction models, these instruments have been widely used in the intensive care unit (ICU), both for patient evaluation and for ICU evaluation. Since some of these uses have been serious questioned, we assisted in the last years to the exploration of alternative paths for increasing the predictive power of the models and to enhance their applicability and utility in the real world. Part of these efforts focused on the exploration of more meaningful outcomes (clinical and non-clinical) with a strong tonic into the relation between outcomes and resources use. Also, since it is now widely recognized that the ICU is not an island, but it is integrated in a continuum of care, more and more efforts are being made to optimize and evaluate the interface between the ICU and the hospital, both at ICU admission and at ICU discharge. The objective of this review is to present and discuss, to the clinician working in the ICU, these emerging issues.

Review article: scoring systems for assessing prognosis in critically ill adult cirrhotics

“…In the future, evaluation of new specific models should preferably be based on a large number of cirrhotics admitted to ICU, 57 validating and comparing them with established scores, including an evaluation of added complications, such as adult respiratory distress syndrome and multisystem organ failure 21, 58 . This may help in deciding when treatment is futile.…”

A nationwide survey of intensive care unit discharge practices

“…A significant number of research groups are focusing their attention on improving the organization of the ICU and defining its place in the continuum of care [1,2,3,4,5]. In addition, geographical, organizational, and socioeconomic conditions are driving forces determining access to health care resources.…”

Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit

“…Severity scoring systems integrate clinical data to estimate the probability of mortality, which can be used to facilitate resource utilization or continuing quality improvement and to stratify patients for clinical research. 1 Several criteria should be taken into consideration when judging the value of any scoring system in clinical practice. Reliability and validity are important issues that allow confident use of a scoring system in intensive care unit (ICU) patients with different case-mixes and baseline characteristics.…”