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[Article] ICU Performance: What is the added value of prognostic scores?

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Prognostic scoring systems were created to standardise the evaluation of illness severity in critically ill patients by converting complex clinical data into objective, measurable metrics. These scores allow clinicians and researchers to assess and compare risk-adjusted outcomes across various patient groups and healthcare environments.

Over the past 40 years (Figure 1), several prognostic models have become well established in clinical practice, including APACHE IV, SAPS 3, MPM0 III, and SOFA. A key distinction between these models lies in the timing and type of data they utilise.

  • SAPS 3 and MPM0-III are calculated using data from the first hour of ICU admission, thus reflecting the initial severity of the non-resuscitated patient.
  • APACHE IV uses the most adverse values recorded during the first 24 hours, enabling more thorough data collection and decreasing the chance of missing variables.
  • The Sequential Organ Failure Assessment (SOFA) score was created to measure the extent of organ dysfunction, especially in sepsis patients, and to track response to treatment over time.

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Figure 1: Timeline of prognostic models and organ dysfunction scores

 

Although these tools are widely utilised, their interpretation requires caution. Their predictive accuracy may differ among specific patient subgroups or specialised ICUs and can be affected by local epidemiology and geoeconomic factors. Furthermore, the effectiveness of prognostic scores may decrease over time due to evolving clinical practices, alterations in case mix, and the adoption of new therapeutic strategies.

The search for the “ideal” ICU prognostic score remains ongoing. Nevertheless, these tools have greatly improved our understanding of severity-adjusted outcomes, providing value beyond the ICU and aiding improvements across the entire healthcare system, as shown below.

 

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Reproduced from: Quintairos A, Pilcher D, Salluh JIF. ICU scoring systems.

Intensive Care Med. 2023 Feb;49(2):223-225. doi: 10.1007/s00134-022-06914-8.

 

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