Generic scoring systems

There have been two main approaches to the development of generic scoring systems for intensive care; one was aimed at measuring severity by treatment intensity, and the other at measuring severity by patient characteristics and physiological measurements.

The scoring system developed to quantify severity of illness for intensive care patients based on the type and amount of treatment received was the Therapeutic Intervention Scoring System (TISS) published in 1974. The underlying philosophy of the developers of TISS was that the sicker the intensive care patient, the greater the number and complexity of treatments given. Therefore a proxy measure of the severity of illness for a patient could be obtained by quantifying the type and amount of treatment provided. TISS was last updated in 1983.

The first generic physiological scoring system developed to quantify severity of illness by patient characteristics was the APACHE method published in 1981. The underlying philosophy of the developers of APACHE was that the wide variety of physiological measurements routinely obtained on intensive care patients contained precise information on severity of illness. Therefore the severity of illness of a patient could be quantified by selecting and weighting the important physiological measurements.

In response to criticism that the APACHE method was too complex and time consuming to use routinely, two further methods were derived from it, the Simplified Acute

Physiology Score (SAPS) published in 1984 and, an update from the original developers, APACHE II, published in 1985. These were both subsequently updated to SAPS II in 1991 and APACHE III in 1993.

Other methods unrelated to the original APACHE method and using a different approach to development (see below), known as the Mortality Prediction Models (MPM), were published in 1988. These were subsequently updated in 1993 to become the Mortality Probability Models (MPM II).

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