Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin

A. Junger; J. Engel; M. Benson; B. Hartmann; R. Röhrig; G. Hempelmann

doi:10.1055/s-2002-34522

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2002; 37(10): 591-599
DOI: 10.1055/s-2002-34522

Übersicht

Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin

Teil II - IntensivmedizinRisk Predictors, Scoring Systems and Prognostic Models in Anesthesia and Intensive Care. Part II Intensive CareA. Junger¹ , J. Engel¹ , M. Benson¹ , B. Hartmann¹ , R. Röhrig¹ , G. Hempelmann¹

¹Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Giessen

Abstract

Zusammenfassung

Im zweiten Teil der Übersichtsarbeit sollen die am häufigsten genutzten Scoring-Systeme und prognostischen Modelle in der Intensivmedizin vorgestellt und deren Nutzen und Limitationen aufgezeigt werden. Universell einsetzbare, krankheitsübergreifende Scoring-Systeme stehen zur Abschätzung der Morbidität, der Mortalität und des therapeutischen Aufwandes zur Verfügung. Die Kosten (Acute Physiology and Chronic Health Evaluation [APACHE] III ist nur kommerziell erhältlich) und der Erhebungsaufwand sind bei der Anwendung zu berücksichtigen. Bezüglich der Qualität der Scoring-Systeme sind prädiktive Modelle der dritten Generation (APACHE III, Simplified Acute Physiology Score [SAPS] II, Mortality Prediction Model [MPM] II) den jeweiligen Vorgängerversionen überlegen. Obwohl es bisher noch keine umfassenden multizentrischen Vergleichsstudien mit den drei gängigsten prognostischen Scoring-Systemen gibt, scheinen alle nützliche Instrumente für Kliniker und Wissenschaftler zu sein. Sie dienen als standardisierte Verfahren zur Klassifizierung des Krankheitsschweregrades, zur Verlaufsbeobachtung bei diagnostischen und therapeutischen Maßnahmen und zur Stratifizierung von Patientenkollektiven bei wissenschaftlichen Untersuchungen. Für das Qualitätsmanagement und die Kosten-Nutzen-Analysen spielen diese Parameter eine wichtige Rolle im Rahmen der Risikoadjustierung und Aufwandsbeschreibung.

Abstract

The aim of the second part of this review article was to describe common scoring systems in intensive care, and to point out their possible benefits and limitations. Intensive care medicine multipurpose scoring-systems are currently used to estimate severity of illness, mortality and the amount of treatment required. Costs (only commercial available scores e.g. Acute Physiology and Chronic Health Evaluation [APACHE] III) and time needed for calculation have to be taken into consideration. Prognostic models of the third generation (APACHE III, Simplified Acute Physiology Score [SAPS] II, Mortality Prediction Model [MPM] II) should be preferred having better prognostic performance compared to scoring systems of prior generations. Although no prospective study exists comparing these three common scoring systems, it appears that all three systems are able to provide useful information to the clinician and researcher. These scoring systems were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance.

Schlüsselwörter

Anästhesie - Intensivmedizin - Krankenhausmortalität - Risikofaktoren - Gesundheitszustand - Risikoklassifizierung

Key words

Anesthesiology - critical care - hospital mortality - risk factors - health status indicators - risk assessment

Full Text

References

Literatur

1 Antonelli M, Moreno R, Vincent J L, Sprung C L, Mendoca A, Passariello M, Riccioni L, Osborn J. Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med. 1999; 25 389-394
2 Apolone G, Bertolini G, D'Amico R, Iapichino G, Cattaneo A, de Salvo G, Melotti R M. The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva. Intensive Care Med. 1996; 22 1368-1378
3 Baker S P, O'Neill B, Haddon W, Long W B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14 187-196
4 Barie P S, Hydo L J, Fischer E. Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness. Arch Surg. 1995; 130 77-82
5 Bein T, Fröhlich D, Frey A, Metz C, Taeger K. Vergleich von APACHE II und APACHE III zur Einschätzung der Erkrankungsschwere von Intensivpatienten. Anaesthesist. 1995; 44 37-42
6 Bein T, Unertl K. Möglichkeiten und Grenzen von Score-Systemen in der Intensivmedizin. Anästhesiol Intensivmed Notfallmed Schmerzther. 1993; 28 476-483
7 Bertolini G, D'Amico R, Apolone G, Cattaneo A, Ravizza A, Iapichino G, Brazzi L, Melotti R M. Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1,393 patients. GiViTi Investigators (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva). Simplified Acute Physiology Score. Med Care. 1998; 36 1371-1382
8 Boyd C R, Tolson M A, Copes W S. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987; 27 370-378
9 Buchardi H. Qualitätsmanagement: Risikoabschätzung, Leistungserfassung, Qualitätssicherung. Van Aken H, Reinhart K, Zimpfer M Intensivmedizin. Thieme, Stuttgart New York 2001: 380-391
10 Castillo-Lorente E, Rivera-Fernandez R, Rodriguez-Elvira M, Vazquez-Mata G. Tiss 76 and Tiss 28: correlation of two therapeutic activity indices on a Spanish multicenter ICU database. Intensive Care Med. 2000; 26 57-61
11 Champion H R, Copes W S, Sacco W J, Lawnick M M, Bain L W, Gann D S, Gennarelli T, Mackenzie E, Schwaitzberg S. A new characterization of injury severity. J Trauma. 1990; 30 539-545
12 Champion H R, Sacco W J, Carnazzo A J, Copes W S, Fouty W J. Trauma score. Crit Care Med. 1981; 9 672-676
13 Champion H R, Sacco W J, Copes W S, Gann D S, Gennarelli T A, Flanagan M E. A revision of the Trauma Score. J Trauma. 1989; 29 623-629
14 Chang R W, Jacobs S, Lee B. Predicting outcome among intensive care unit patients using computerised trend analysis of daily Apache II scores corrected for organ system failure. Intensive Care Med. 1988; 14 558-566
15 Chang R W, Jacobs S, Lee B, Pace N. Predicting deaths among intensive care unit patients. Crit Care Med. 1988; 16 34-42
16 Chen F G, Khoo S T. Critical care medicine - a review of the outcome prediction in critical care. Ann Acad Med Singapore. 1993; 22 360-364
17 Chen F G, Koh K F, Goh M H. Validation of APACHE II score in a surgical intensive care unit. Singapore Med J. 1993; 34 322-324
18 Chen L M, Martin C M, Morrison T L, Sibbald W J. Interobserver variability in data collection of the APACHE II score in teaching and community hospitals. Crit Care Med. 1999; 27 1999-2004
19 Clermont G, Angus D C, Linde-Zwirble W T, Lave J R, Pinsky M R. Measuring resource use in the ICU with computerized therapeutic intervention scoring system-based data. Chest. 1998; 113 434-442
20 Cowley R A, Sacco W J, Gill W, Champion H R, Long W B, Copes W S, Goldfarb M A, Sperrazza J. A prognostic index for severe trauma. J Trauma. 1974; 14 1029-1035
21 Cullen D J, Civetta J M, Briggs B A, Ferrara L C. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med. 1974; 2 57-60
22 Cullen D J, Keene R, Waternaux C, Kunsman J M, Caldera D L, Peterson H. Results, charges, and benefits of intensive care for critically ill patients: update 1983. Crit Care Med. 1984; 12 102-106
23 Cullen D J, Nemeskal A R, Zaslavsky A M. Intermediate TISS: a new Therapeutic Intervention Scoring System for non-ICU patients. Crit Care Med. 1994; 22 1406-1411
24 de Mendonca A, Vincent J L, Suter P M, Moreno R, Dearden N M, Antonelli M, Takala J, Sprung C, Cantraine F. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000; 26 915-921
25 Dragsted L, Jorgensen J, Jensen N H, Bonsing E, Jacobsen E, Knaus W A, Qvist J. Interhospital comparisons of patient outcome from intensive care: importance of lead-time bias. Crit Care Med. 1989; 17 418-422
26 Draper E, Wagner D, Russo M, Bergner M, Shortell S, Rousseau D, Gillies R, Knaus W. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Study design - data collection. Crit Care Med. 1989; 17 S186-193
27 Elebute E A, Stoner H B. The grading of sepsis. Br J Surg. 1983; 70 29-31
28 Ferreira F L, Bota D P, Bross A, Melot C, Vincent J L. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001; 286 1754-1758
29 Fery-Lemonnier E, Landais P, Loirat P, Kleinknecht D, Brivet F. Evaluation of severity scoring systems in ICUs - translation, conversion and definition ambiguities as a source of inter-observer variability in Apache II, SAPS and OSF. Intensive Care Med. 1995; 21 356-360
30 Giangiuliani G, Mancini A, Gui D. Validation of a severity of illness score (APACHE II) in a surgical intensive care unit. Intensive Care Med. 1989; 15 519-522
31 Goris R J, te Boekhorst T P, Nuytinck J K, Gimbrere J S. Multiple-organ failure. Generalized autodestructive inflammation?. Arch Surg. 1985; 120 1109-1115
32 Greenspan L, McLellan B A, Greig H. Abbreviated Injury Scale and Injury Severity Score: a scoring chart. J Trauma. 1985; 25 60-64
33 Jacobs S, Chang R W, Lee B. One year's experience with the APACHE II severity of disease classification system in a general intensive care unit. Anaesthesia. 1987; 42 738-744
34 Janssens U, Graf C, Graf J, Radke P W, Konigs B, Koch K C, Lepper W, vom Dahl J, Hanrath P. Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders. Sequential Organ Failure Assessment. Intensive Care Med. 2000; 26 1037-1045
35 Junger A, Böttger S, Engel J, Benson M, Michel A, Röhrig R, Jost A, Hempelmann G. Automatic Calculation of a Modified APACHE II Score Using a Patient Data Management System (PDMS). Int J Med Inf. 2002; 1 145-157
36 Junger A, Engel J, Böttger S, Grabow C, Hartmann B, Michel A, Röhrig R, Marquardt K, Hempelmann G. Discriminative Power on Mortality of a Modified SOFA Score for Complete Automatic Computation in an Operative ICU. Crit Care Med. 2002; 30 338-342
37 Junger A, Hartmann B, Benson M, Schindler E, Dietrich G, Jost A, Beye-Basse A, Hempelmannn G. The use of an anesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit. Anesth Analg. 2001; 92 1203-1209
38 Kearney T J, Shabot M M. Automated severity scoring in level I trauma patients. Am Surg. 1994; 60 391-393
39 Keene A R, Cullen D J. Therapeutic Intervention Scoring System: update 1983. Crit Care Med. 1983; 11 1-3
40 Knaus W, Draper E, Wagner D. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Introduction. Crit Care Med. 1989; 17 S176-180
41 Knaus W, Wagner D. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Individual patient decisions. Crit Care Med. 1989; 17 S204-209
42 Knaus W, Wagner D, Draper E. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Development of APACHE. Crit Care Med. 1989; 17 S181-185
43 Knaus W, Wagner D, Draper E. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Implications. Crit Care Med. 1989; 17 S219-221
44 Knaus W A, Draper E A, Wagner D P, Zimmerman J E. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13 818-829
45 Knaus W A, Draper E A, Wagner D P, Zimmerman J E. Prognosis in acute organ-system failure. Ann Surg. 1985; 202 685-693
46 Knaus W A, Draper E A, Wagner D P, Zimmerman J E, Birnbaum M L, Cullen D J, Kohles M K, Shin B, Snyder J V. Evaluating outcome from intensive care: a preliminary multihospital comparison. Crit Care Med. 1982; 10 491-496
47 Knaus W A, Harrell F E, Fisher C J, Jr. , Wagner D P, Opal S M, Sadoff J C, Draper E A, Walawander C A, Conboy K, Grasela T H. The clinical evaluation of new drugs for sepsis. A prospective study design based on survival analysis. JAMA. 1993; 270 1233-1241
48 Knaus W A, Le G all, Wagner D P, Draper E A, Loirat P, Campos R A, Cullen D J, Kohles M K, Glaser P, Granthil C, Mercier P, Nicolas F, Nikki P, Shin B, Snyder J V, Wattel F, Zimmerman J E. A comparison of intensive care in the U.S.A. and France. Lancet. 1982; 2 642-646
49 Knaus W A, Wagner D P, Draper E A, Zimmerman J E, Bergner M, Bastos P G, Sirio C A, Murphy D J, Lotring T, Damiano A. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991; 100 1619-1636
50 Knaus W A, Wagner D P, Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science. 1991; 254 389-394
51 Knaus W A, Wagner D P, Zimmerman J E, Draper E A. Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993; 118 753-761
52 Knaus W A, Zimmerman J E, Wagner D P, Draper E A, Lawrence D E. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981; 9 591-597
53 Le G all, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA. 1996; 276 802-810
54 Le Gall J R, Lemeshow S, Leleu G, Klar J, Huillard J, Rue M, Teres D, Artigas A. Customized probability models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group. JAMA. 1995; 273 644-650
55 Le G all, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993; 270 2957-2963
56 Le Gall J R, Loirat P. Can we evaluate the performance of an intensive care unit. Curr Opin Crit Care. 1995; 1 219-220
57 Le Gall J R, Loirat P, Alperovitch A. Simplified acute physiological score for intensive care patients. Lancet. 1983; 2 741
58 Le Gall J R, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D. A simplified acute physiology score for ICU patients. Crit Care Med. 1984; 12 975-977
59 Lefering R, Zart M, Neugebauer E A. Retrospective evaluation of the simplified Therapeutic Intervention Scoring System (TISS-28) in a surgical intensive care unit. Intensive Care Med. 2000; 26 1794-1802
60 Lemeshow S, Klar J, Teres D, Avrunin J S, Gehlbach S H, Rapoport J, Rue M. Mortality probability models for patients in the intensive care unit for 48 or 72 hours: a prospective, multicenter study. Crit Care Med. 1994; 22 1351-1358
61 Lemeshow S, Le Gall J R. Modeling the severity of illness of ICU patients. A systems update. JAMA. 1994; 272 1049-1055
62 Lemeshow S, Teres D, Avrunin J S, Gage R W. Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med. 1988; 16 470-477
63 Lemeshow S, Teres D, Avrunin J S, Pastides H. A comparison of methods to predict mortality of intensive care unit patients. Crit Care Med. 1987; 15 715-722
64 Lemeshow S, Teres D, Klar J, Avrunin J S, Gehlbach S H, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993; 270 2478-2486
65 Lemeshow S, Teres D, Pastides H, Avrunin J S, Steingrub J S. A method for predicting survival and mortality of ICU patients using objectively derived weights. Crit Care Med. 1985; 13 519-525
66 Malstam J, Lind L. Therapeutic intervention scoring system (TISS) - a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand. 1992; 36 758-763
67 Markgraf R, Deutschinoff G, Pientka L, Scholten T. Comparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit. Crit Care Med. 2000; 28 26-33
68 Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C. Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. Crit Care. 2001; 5 31-36
69 Marshall J, Sweeney D. Microbial infection and the septic response in critical surgical illness. Sepsis, not infection, determines outcome. Arch Surg. 1990; 125 17-22
70 Marshall J C, Cook D J, Christou N V, Bernard G R, Sprung C L, Sibbald W J. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995; 23 1638-1652
71 McClish D K, Powell S H. How well can physicians estimate mortality in a medical intensive care unit?. Med Decis Making. 1989; 9 125-132
72 Metnitz P G, Hiesmayr M, Lenz K, Popow C, Valentin A, Vesely H, Mühlbacher F, Steltzer H. Interdisziplinäre Dokumentation, Leistungserfassung und Qualitätssicherung in der österreichischen Intensivmedizin. Anästhesiol Intensivmed Notfallmed Schmerzther. 1997; 32 375-379
73 Metnitz P G, Lang T, Vesely H, Valentin A, LeGall J R. Ratios of observed to expected mortality are affected by differences in case mix and quality of care. Intensive Care Med. 2000; 26 1466-1472
74 Metnitz P G, Valentin A, Vesely H, Alberti C, Lang T, Lenz K, Steltzer H, Hiesmayr M. Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study. Simplified Acute Physiology Score. Intensive Care Med. 1999; 25 192-197
75 Miranda D R. Outcome assessment - TISS as a tool to evaluate cost-effectiveness of immunological treatment. Eur J Surg Suppl. 1999; 165 51-55
76 Miranda D R, de Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System: the TISS-28 items - results from a multicenter study. Crit Care Med. 1996; 24 64-73
77 Moreno R, Apolone G, Miranda D R. Evaluation of the uniformity of fit of general outcome prediction models. Intensive Care Med. 1998; 24 40-47
78 Moreno R, Metnitz P G, Edbrooke D, Le Gall J R. SAPS III - From the Evaluation of the individual Patient to the Evaluation of the ICU. www.saps3.org 2002
79 Moreno R, Miranda D R, Fidler V, van Schilfgaarde R. Evaluation of two outcome prediction models on an independent database. Crit Care Med. 1998; 26 50-61
80 Moreno R, Morais P. Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive Care Med. 1997; 23 177-186
81 Moreno R, Vincent J L, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med. 1999; 25 686-696
82 Muhl E, Hansen M, Brandt J, Bruch H P. Neue Nutzung alter Scores - APACHE-II-Score und TISS zur Erfassung der Leistungsentwicklung einer operativen Intensivstation. Intensivmed. 2001; 38 654-653
83 Murray J F, Matthay M A, Luce J M, Flick M R. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988; 138 720-723
84 Oestern H J, Sturm J, Lobenhoffer P, Nerlich M, Schiemann M, Tscherne H. Möglichkeiten zur Klassifizierung von Verletzungen beim Polytrauma. Chir For. 1983; 83 197-199
85 Polderman K H, Christiaans H M, Wester J P, Spijkstra J J, Girbes A R. Intra-observer variability in APACHE II scoring. Intensive Care Med. 2001; 27 1550-1552
86 Polderman K H, Girbes A R, Thijs L G, Strack v an. Accuracy and reliability of APACHE II scoring in two intensive care units - problems and pitfalls in the use of APACHE II and suggestions for improvement. Anaesthesia. 2001; 56 47-50
87 Polderman K H, Thijs L G, Girbes A R. Interobserver variability in the use of APACHE II scores. Lancet. 1999; 353 380
88 Pollack M M, Patel K M, Ruttimann U E. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996; 24 743-752
89 Pollack M M, Patel K M, Ruttimann U E. The Pediatric Risk of Mortality III - Acute Physiology Score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients. J Pediatr. 1997; 131 575-581
90 Pollack M M, Ruttimann U E, Getson P R. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988; 16 1110-1116
91 Rivera-Fernandez R, Vazquez-Mata G, Bravo M, Aguayo-Hoyos E, Zimmerman J, Wagner D, Knaus W. The Apache III prognostic system: customized mortality predictions for Spanish ICU patients. Intensive Care Med. 1998; 24 574-581
92 Rue M, Valero C, Quintana S, Artigas A, Alvarez M. Interobserver variability of the measurement of the mortality probability models (MPM II) in the assessment of severity of illness. Intensive Care Med. 2000; 26 286-291
93 Rutledge R, Fakhry S M, Rutherford E J, Muakkassa F, Baker C C, Koruda M, Meyer A A. Acute Physiology and Chronic Health Evaluation (APACHE II) score and outcome in the surgical intensive care unit: an analysis of multiple intervention and outcome variables in 1,238 patients. Crit Care Med. 1991; 19 1048-1053
94 Schönhofer B, Lefering R, Suchi S, Köhler D. Umfrage zur Einschätzung von Score-Systemen durch Intensivmediziner. Intensivmed. 2002; 39 240-245
95 Schuster H P. Status des Qualitätsmanagements in der Intensivmedizin. Intensivmed. 1997; 34 230-236
96 Schuster H P, Assel R J, Weilemann L S. Aussagekraft des „Therapeutic Intervention Scoring System” (TISS) bei kritisch Kranken einer internen Intensivstation. Med Klin. 1986; 81 117-121
97 Schuster H P, Schuster F P, Ritschel P, Wilts S, Bodmann K F. The ability of the Simplified Acute Physiology Score (SAPS II) to predict outcome in coronary care patients. Intensive Care Med. 1997; 23 1056-1061
98 Schuster H P, Wilts S, Ritschel P. Analyse einer Ergebnisqualitätskontrolle in der Intensivmedizin mittels des Simplified Acute Physiology Score (SAPS) II. Med Klin. 1996; 91 343-348
99 Schuster H P, Wilts S, Ritschel P, Schuster F P. Voraussagekraft von Scoreparametern des Simplified Acute Physiology Score (SAPS)-II für die Behandlungsdauer von Intensivpatienten. Wien Klin Wochenschr. 1996; 108 462-466
100 Second European Consensus Conference in Intensive Care Medicine . Predicting outcome in ICU patients. Intensive Care Med. 1994; 20 390-397
101 Shabot M M, Leyerle B J, LoBue M. Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet. Am J Surg. 1987; 154 72-78
102 Shime N, Kageyama K, Ashida H, Tanaka Y. Application of modified sequential organ failure assessment score in children after cardiac surgery. J Cardiothorac Vasc Anesth. 2001; 15 463-468
103 Smith L, Orts C M, O'Neil I, Batchelor A M, Gascoigne A D, Baudouin S V. TISS and mortality after discharge from intensive care. Intensive Care Med. 1999; 25 1061-1065
104 Taubert G, Menzel H, Lewejohann J C, Kurowski V PJ, Dietrich K W, Djonlagic C. Robustheit eines prognostischen Indexes am Beispiel des MPM. Intensivmed. 1996; 33 323-326
105 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2 81-84
106 Teres D, Lemeshow S. When to customize a severity model. Intensive Care Med. 1999; 25 140-142
107 Teres D, Lemeshow S, Avrunin J S, Pastides H. Validation of the mortality prediction model for ICU patients. Crit Care Med. 1987; 15 208-213
108 Unertl K, Kottler B M. Prognostische Scores in der Intenisvmedizin. Anaesthesist. 1997; 46 471-480
109 Vazquez M G, Mar Jimenez Q M, Rivera F R, Bravo M, Aguayo D H, Zimmerman J, Wagner D, Knaus W. Severity assessment by APACHE III system in Spain. Med Clin (Barc). 2001; 117 446-451
110 Vincent J L, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P M, Sprung C L, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on „sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26 1793-1800
111 Vincent J L, Moreno R, Takala J, Willatts S, de Mendonca A, Bruining H, Reinhart C K, Suter P M, Thijs L G. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22 707-710
112 Wagner D, Draper E, Knaus W. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Analysis: quality of care. Crit Care Med. 1989; 17 S210-S212
113 Wagner D, Draper E, Knaus W. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Development of APACHE III. Crit Care Med. 1989; 17 S199-S203
114 Wagner D, Knaus W, Bergner M. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Statistical methods. Crit Care Med. 1989; 17 S194-S198
115 Wehler M, Kokoska J, Reulbach U, Hahn E G, Strauss R. Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems. Hepatology. 2001; 34 255-261
116 Zeldin R A. Assessing cardiac risk in patients who undergo noncardiac surgical procedures. Can J Surg. 1984; 27 402-404
117 Zhu B P, Lemeshow S, Hosmer D W, Klar J, Avrunin J, Teres D. Factors affecting the performance of the models in the Mortality Probability Model II system and strategies of customization: a simulation study. Crit Care Med. 1996; 24 57-63
118 Zylka-Menhorn V. „Todescomputer”: Risikobewertung von Intensivpatienten. Dt Ärztebl. 1997; 94 B-501

Dr. med. Axel Junger

Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Giessen

Rudolf-Buchheim-Str. 7

35392 Giessen

Email: Axel.Junger@chiru.med.uni-giessen.de