Prognostication and intensive care unit outcome: the evolving role of scoring systems
Section snippets
General overview of importance and limitations of scoring systems
Scoring systems were initially developed to provide some quantification of case mix and estimates of outcome probabilities, where outcome was usually measured as death. The following is a brief and generic discussion of the relative merits and limitations of scoring systems as originally outlined by Rowan [10].
Scoring systems: prognostic scores versus organ dysfunction (outcome) measures
The goals for each of these scoring systems are different but may be seen as complementary. The prognostic scales were designed to be used early during the ICU stay, typically in the first 24 hours following admission. They are based on physiologic measures that were selected to maximize prediction of mortality. Organ dysfunction measures capture the clinical course over time and can be determined at any point during the ICU stay. They are based on measures of physiology and therapeutic
Summary
Prognostic scoring systems remain important in clinical practice. They enable us to characterize our patient populations with robust measures for predicted mortality. This allows us to audit our own experience in the context of institutional quality control measures and facilitates, albeit imperfectly, comparisons across units and patient populations. Practically, they provide an objective means to characterize case-mix and this helps to quantify resource needs when negotiating with hospital
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The role and limitations of scoring systems
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Cited by (57)
Comparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: A linked-data cohort study
2012, Journal of Critical CareCitation Excerpt :Prognostic scoring systems to predict hospital mortality in patients admitted to the intensive care unit (ICU) are used extensively for quality assurance and research purposes [1]. Despite progressive refinements that have improved the discrimination and calibration of these models at the population level, at the individual patient level, they continue to have limited accuracy and, hence, utility [2]. Previous studies have suggested that intensive care physicians may be better than prognostic models in predicting hospital mortality in critically ill patients [3].
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