ICU severity scores - Severity scores in ICU DM seminar...

Info iconThis preview shows pages 1–13. Sign up to view the full content.

View Full Document Right Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Severity scores in ICU DM seminar Dr.Vamsi Krishna Mootha Dept of Pulmonary medicine, PGIMER Introduction Severity of illness scoring systems are developed to evaluate delivery of care and provide prediction of outcome of groups of critically ill patients who are admitted to intensive care units Why do we need severity scoring systems ? Potential uses of severity scoring systems: • In RCTs and clinical research • To assess ICU performance • Assess individual patient prognosis and guide care • Administrative purposes Ideal variables • Objective • Simple • Well defined • Reproducible • Widely available • Continuous variable • Measurements or data collected routinely in the course of patient care Appraisal of scoring systems • Reliability : good inter-observer agreement • Content validity: appropriate number of variables • Methodological rigor: avoidance of local bias avoidance of unusual data consistency in data collection rules dealing with missing data • Discrimination • Calibration Discrimination • Ability of score to distinguish a survivor from non survivor • Area under ROC: 0.5 – chance performance 1 perfect prediction • 0.8 accepted cut-off randomly selected non- survivor has 90% chance of having severe score than survivor Calibration • Agreement between observed and predicted mortality in within severity strata • Hosmer – Lameshow goodness of fit test • Lower the Χ ² value, better the calibration Severity scores in Medical and Surgical ICU 1980-85: APACHE SAPS APACHE II 1990-95: APACHE III MODS MPM II ODIN 1996-2000: SOFA CIS 2000- current SAPS III APACHE IV 1986-1990: SAPS II MPM Numerous scoring systems for trauma, burns, cardiac surgery patients Numerous scoring systems for pediatric patients APACHE II • Disease specific scoring system • Validated in 5815 ICU patients • APACHE II score (0-67) is sum of Acute physiology score GCS Age and chronic health score • Hospital mortality is predicted from APACHE II score Diagnostic category (choose 1 from 50) Need for emergency surgery • Predicted death rate: Logit = -3,517+( Apache II) 0.146 • Predicted Death Rate (adjusted): Logit = -3,517+( Apache II) 0.146 +diagnostic category weight • Limitations: Failure to compensate for lead time bias Requirement to choose one disease Poor inter-observer reliability Crit care med 1985;13:818-829 APACHE II APACHE III • To improve the risk prediction by reevaluating the selection and weighting of physiologic variables • To examine how differences in patient selection for and timing of admission to ICUs related to outcome • To clarify the distinction between risk of mortality within independently defined patient groups Vs individual risks • The selection of patients and the timing of scoring APACHE III • Not applicable for patients aged <16 yrs and patients with burns/ MI • APACHE III score (0-299) is sum of Acute physiology score (0-252) Age score (0-24) Chronic health score (0-23) Worst values in 24 hrs taken into account...
View Full Document

This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

Page1 / 49

ICU severity scores - Severity scores in ICU DM seminar...

This preview shows document pages 1 - 13. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online