Gen - Scoring Systems

Question 1

What type of scoring systems are available?

Answer 1

1. Disease specific scores (Child-Pugh, Wells, CURB 65, CHADS VASc, GRACE, Glasgow-Imrie)2. Physiological and illness severity scores (APACHE II, SOFA, ICNARC, MODS, TISS)

Question 2

What are the features of an ideal scoring system?

Answer 2

1. Valid2. Simple3. Discriminatory (plot sensitivity/specificity curve to get AUROC - should be at least 0.74. Calibrated5. Transferrable6. Generateable from readily available data

Question 3

What are scoring systems used for?

Answer 3

1. To assess performance of ICU care and outcomes2. To assess patient’s risk of mortality3. To compare populations4. To facilitate audit5. To tailor treatment

Question 4

How can we compare different ICUs?

Answer 4

1. Outcome-based:- SMR - ICNARC case mix programme- CRBSI rate- VTE rate- MRSA rate- unit based bacteraemia2. Process-based: - Audit participation- delirium screening- FAST HUG- early EN- hand hygiene compliance- VTE assessments.3. Structure-based: GPICS standards (consultant cover, nurse:patient ratio, % days at full occupancy, MDT ward rounds, ICU follow-up)

Question 5

What is the standardised mortality rate?

Answer 5

SMR = observed mortality/predicted mortalityProblems with it include:- doesn’t take into account pre-hospital or pre-ICU care discrepancies- doesn’t take into account case-mix- doesn’t take into account local baseline health and deprivation- there may be varying application of scoring systems

Question 6

What is the CURB 65 score?

Answer 6

Confusion - newUrea >7.0RR >30Blood pressure <90Age >65

Each scores 1Increased score associated with increased mortality (4 = 40%)Score >3 is severe and likely needing ICU admission.