W. Wahl et al., EXPERIENCES WITH VARIOUS SCORES FOR THE A SSESSMENT OF THE PROGNOSIS IN POSTOPERATIVE CRITICAL CARE PATIENTS, Chirurg, 67(7), 1996, pp. 710-717
At the intensive care unit of the Clinic for General and Abdominal Sur
gery and the Clinic for Emergency Medicine in Mainz, various scores (A
PACHE II score, HIS, TISS, ASA score), laboratory parameters (serum cr
eatinine, white blood count, platelet count: serum lactate, serum elas
tase, Quick), body temperature, age as well as presence of a malignant
underlying or associated disease, were analyzed with regard to their
prognostic significance in 169 postoperative admissions. Apart from un
ivariate analysis (Wilcoxon test) and a multivariate analysis (stepwis
e logistic regression), the value of the scores is demonstrated on the
basis of sensitivity, specificity and correctness, as well as the beh
aviour of the scores at certain decisive points (cut-off point). Of th
e parameters studied, the APACHE II score, the HISS, the TISS and seru
m lactate had a significant influence on the outcome of intensive care
. Examination of these scores and serum lactate at different decisive
points (false-positive rate of 0%, point of highest sensitivity, point
of maximal correctness) showed the TISS to have the best results. The
TISS has, with a sensitivity of 100%, a false-positive rate of 41%, c
ompared with 55% for the HIS, 81% for the APACHE II and 82% for serum
lactate. With a false-positive rate of 0%. the sensitivity of the TISS
is only 10%, of APACHE TI and serum lactate 5% and of the HIS 0%. The
patient with the highest HIS score has survived. The serum lactate le
vel is another good parameter that is a lot easier to determine and is
comparable to the APACHE II score and the HIS in its prognostic signi
ficance. Thus, scores are suitable for the estimation of the prognosis
in certain patient groups. However, insufficient discrimination betwe
en patients who die and patients who survive means that these paramete
rs cannot be used for individual therapeutic decisions in severely ill
patients. The decision between the institution or cessation of intens
ive care is made by the physician or the medical team. Due to the use
of prognostic factors. such as scores. decision-making can be objectif
ied and therefore made easier.