Severity of illness scoring systems |
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| Affiliation: | 1. Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands;2. Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands;1. Centre for Health Economics, University of York, York, UK;2. Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK;3. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;4. Department of Global Health and Population, Harvard University, Harvard T.H. Chan School of Public Health, Boston, MA, USA;1. Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway;2. Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318, Oslo, Norway;3. Department of Forensic Sciences, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway;4. Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway;5. Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway;6. Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Postboks 1122 Blindern, 0317, Oslo, Norway;7. Medicine, Health, Patient Safety and Integration, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway |
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| Abstract: | ![]()
Data collection on the ICU is necessary to facilitate research, quality assurance and resource management. Severity of illness scoring systems aid the case-mix adjusted collection of such data. However, none is perfect and their use to triage individual patients or to compare the quality of care in different ICUs is severely limited. An appreciation of their limitations and the statistical methods of assessing their goodness of fit are vital if the information that they provide is to be used appropriately.Potential uses for scoring systems include: - •case-mix adjustment for entry into randomized controlled trials
- •audit and comparison of ICU performance
- •a mechanism to decide resource allocation.
Scoring systems use a logistic regression equation based, variably, on disease severity, age and diagnosis to derive the probability of hospital death (on a scale of 0 to 1, where 0 = survival and 1 = death). The standardized mortality ratio (SMR) describes the ratio of expected to observed deaths. Case-mix variation and the need to derive binary (live or die) data from a probability estimate, limit the use of such systems to evaluate ICU performance. |
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