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

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

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