Scoring Sytems in Icu

Scoring systems as a prognostic predictors: Several objective systems based on statistically validated determinants of outcome have been developed during the last 15 years. In general, these system include physiologic variables, diagnosis, age and previous health status. Recently, measurement over time have been used to refine predictions from these systems(Osborne,1992). The ideal predictive scoring system would use objective, simply measured predictors. For prediction models to become universally accepted, not only will they have to be validated in terms of their predictive accuracy but they also need to be easily implemented in the ICU environment. The progressive automation of data collection in modern ICUs offer an opportunity to implement scoring systems into daily decision making(Kollef and Schuster,1994).

Classification of scoring systems:
(modified after Roberts and Zimmerman,1995)
1-Disease-specific severity systems e.g.: *Acute myocardial infarction *Acute pancreatitis *Adult respiratory distress syndrome(ARDS) *Liver cirrhosis
2-System-specific severity system e.g.: Glasgow Coma Scale Score(GCS)
3-General severity scoring systems e.g.: *Therapeutic intervention scoring system(TISS) *Acute Physiology and Chronic Health Evaluation(APACHE)systems: -original APACHE -APACHE II -APACHE III *Simpified Acute Physiology Score (SAPS)and SAPS II *Sickness Score *Mortality Probability Model(MPM) and MPM II *Multiple Organ Dysfunction/Failure scores

I-Disease specific severity systems:
Example:Adult respiratory distress syndrome(ARDS) Murray et al.,(1988)designed a quantitative lung injury score which assigned points for each of four variables; extent of disease by chest roentgenogram, hypoxemia, lung compliance and level of required PEEP.

Identification of the associated illness also affect prognostic estimates because