Approaches to the development of generic scoring systems in intensive care

The developers of generic scoring systems in intensive care have adopted either a subjective theoretical approach or a more objective empirical approach to decide which factors (treatments, patient characteristics, physiological measurements) should be included in the score and how they should be weighted.

The subjective theoretical approach involves the prior selection and weighting of factors based on past studies and expert opinion. The developers of TISS and the original APACHE method used this approach in their scoring systems.

In contrast, the developers of MPM adopted the more objective empirical approach by collecting information on many patient factors during treatment and, at the conclusion of treatment, identified those statistically associated with outcome, survival, or non-survival. A combination of univariate and multivariate statistical techniques was then used to reduce the large number of potential factors to a smaller subset and to weight the final factors.

Apart from TISS, an objective empirical approach was used to develop all the scoring systems currently proposed for use in adult intensive care today—APACHE II, APACHE III, SAPS II, MPM II, and TISS.

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