Stratification of ICU patients

The intensive care population can be stratified into three major groups, with the most critically ill being class IV ( Table 2).

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Tabie 2 Patient classes and TISS points

Class IV patients are physiologically unstable, requiring intensive nursing and physician care with frequent observations and change of orders by their physicians. These patients usually have multiple organ or multiple system dysfunction. A more objective and quantitative method of measuring the severity of illness in class IV

critically ill patients resulted in a further extension of TISS ( CuJJen §t..a.L 1984). We objectively and quantitatively defined severity of illness and demonstrated the extreme nature of class IV critical illness.

Class III patients are physiologically stable, but require intensive nursing care, invasive monitoring, and predictable medical care. Their condition is expected to remain stable or improve, with early return to general floor care expected. These patients usually have no more than one organ or system requiring major supportive therapy.

Class II patients require intensive monitoring (but no therapy) to detect potential catastrophes.

Class I patients do not require intensive monitoring or therapy and therefore do not need the facilities of an ICU.

The excellent separation of the classes by TISS score suggests that clinical classification of patients into these four groups provides a practical method of describing the ICU population (Table.2). The mortality of class IV patients is very high, with 73 per cent of patients dying within 1 year ( Cujieo §L§L 1976).

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