Organ dysfunction scoringthe future

A scoring system does not provide new information, but merely combines multiple divergent factors into a single variable.

The greatest potential use of organ dysfunction scores is as an objective measure of clinical outcome that can be used in ICU-based clinical trials. Such scales are more sensitive than mortality to clinically important effects of therapy, and therefore can facilitate the performance of studies by permitting smaller sample sizes. Calculation of severity of illness at the time of admission to the study permits more refined patient stratification. Objective systems for describing organ dysfunction are a prerequisite to studies of the epidemiology and pathophysiology of the syndrome. Moreover, the availability of objective measures of ICU morbidity and mortality has an obvious contribution to make to quality assurance activities.

The clinical utility of such scores has yet to be widely evaluated. Clearly, the science of prognostication is not sufficiently evolved to allow decisions regarding continuation or cessation of therapy on the basis of an organ dysfunction score. However, in patients with a complex disease process, such scales may show evidence of net clinical improvement or deterioration that can provide support for a particular approach to therapy or suggest the need for clinical re-evaluation.

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