Key messages

• Scoring systems are methods designed to quantify and reduce a number of discrete but interrelated patient characteristics to a single value.

• Scoring systems can be either specific, relating to only certain types of intensive care patients, or generic, relating to all types of intensive care patients.

• Scoring systems can be developed employing two different approaches: a subjective theoretical approach where, prior to data collection, experts determine the inclusion and weighting of different factors in the score, or an objective empirical approach where, after data collection, the statistical relationship between each factor and the outcome determine its inclusion and weight in the score.

• Analysis of the relationship between the score and outcome (usually death before discharge from hospital following intensive care) in large databases of intensive care patients has led to the development of models to estimate probabilities of outcome.

• The accuracy of a scoring system should be examined by testing the validity and reliability of the score.

• The accuracy of a probability model should be examined by testing the goodness of fit of the model on an independent set of data. Introduction

Scoring systems are not unique to intensive care; they have been developed and are used in many other areas of health care ( Ie.z.zo.n.!,,,1...9.94). Before discussing the principles of scoring systems in intensive care, it is important to define what is meant by a scoring system, to describe briefly the history of the development of scoring systems in intensive care, to outline the approaches employed in the development of the scoring systems proposed for use, and to relate scoring systems to models derived to estimate probabilities of a particular outcome.

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