When and how are the variables measured

Physiological function in an unstable critically ill patient is in a constant state of flux. Moreover, the frequency with which tests are performed varies between centers, introducing a significant potential for sampling bias.

The approach selected to minimize artefactual overestimation of the score comprises three elements.

• Only post-resuscitation values are used in calculation of the MOD score.

• The value recorded for a given variable on a particular day is a representative value for that variable, rather than the worst value. This is most readily accomplished by recording the value at a constant time (e.g. the first value of the day).

• Missing or unobtainable values are presumed to be normal and scored zero. Thus the Glasgow Coma Scale (GCS) in an anesthetized patient is considered normal, as is the PAR in a patient who does not have a central venous pressure line. However, when scores are calculated daily, the previous value of a missing variable is brought forward; thus if the creatinine is not measured on a given day, the first previous value is used.

Finally, to maximize the simplicity of the score, variables are measured without consideration of the therapy employed.

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