Serial measurement of Therapeutic Intervention Scoring System-28 (TISS-28) in a surgical intensive care unit
ABSTRACT The aim of the study was to assess the use of the Therapeutic Intervention Scoring System-28 (TISS-28) in surgical intensive care unit (ICU) patients and the relationship of the score to the type of surgery, severity of illness, and outcome in these patients.
Prospectively collected data from all patients admitted to a postoperative ICU between March 1, 2004, and June 30, 2006, were analyzed retrospectively.
A total of 6903 patients were admitted during the study period (63.5% male; mean age, 62.3 years) constituting 29 140 observation days. The mean Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), and TISS-28 scores on the day of ICU admission were 36.9 ± 18.2, 5.8 ± 3.9, and 43.2 ± 10.8, respectively. The highest admission TISS-28 was observed in patients who underwent cardiothoracic surgery (47.7 ± 10.1), the lowest in neurosurgical patients (40 ± 9.6), and both declined during the 2 weeks after ICU admission; however, in trauma patients and those admitted after gastrointestinal surgery, TISS scores increased gradually after the first 2 to 5 days in the ICU. The TISS-28 score was moderately correlated to SAPS II (R(2) = 0.42; P < .001) and SOFA score (R(2) = 0.48; P < .001) throughout the ICU stay and was consistently higher in nonsurvivors than in survivors during the first 2 weeks in the ICU.
There are marked variations in TISS-28 scores according to the type of surgery. Therapeutic Intervention Scoring System-28 correlates with the severity of illness and outcome in these patients.
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ABSTRACT: Little is known on the impact of risk factors that may complicate the course of critical illness. Scoring systems in ICUs allow assessment of the severity of diseases and predicting mortality.Objectives Apply commonly used scores for assessment of illness severity and identify the combination of factors predicting patient’s outcome.Methods We included 231 patients admitted to PICU of Cairo University, Pediatric Hospital. PRISM III, PIM2, PEMOD, PELOD, TISS and SOFA scores were applied on the day of admission. Follow up was done using SOFA score and TISS.ResultsThere were positive correlations between PRISM III, PIM2, PELOD, PEMOD, SOFA and TISS on the day of admission, and the mortality rate (p < 0.0001). TISS and SOFA score had the highest discrimination ability (AUC: 0.81, 0.765, respectively). Significant positive correlations were found between SOFA score and TISS scores on days 1, 3 and 7 and PICU mortality rate (p < 0.0001). TISS had more ability of discrimination than SOFA score on day 1 (AUC: 0.843, 0.787, respectively).Conclusion Scoring systems applied in PICU had good discrimination ability. TISS was a good tool for follow up. LOS, mechanical ventilation and inotropes were risk factors of mortality.The Gazette of the Egyptian Paediatric Association 11/2014; DOI:10.1016/j.epag.2014.10.003
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ABSTRACT: Background Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.BMC Surgery 11/2014; 14(1-1):92. DOI:10.1186/1471-2482-14-92 · 1.24 Impact Factor
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ABSTRACT: Background From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. Methods This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fisher's exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. Findings The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (±18.6) and the mean NAS was 71.3% (±16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. Conclusion Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.PLoS ONE 11/2014; 9(11):e112125. DOI:10.1371/journal.pone.0112125 · 3.53 Impact Factor