THE HEIDELBERG INTENSIVE WARD SCORE - DEVELOPMENT OF A COMPUTERIZED SCORING SYSTEM FOR DOCUMENTATION OF THE COURSE OF TREATMENT AND ASSESSMENT OF THE PROGNOSIS OF SURGICAL PATIENTS IN INTENSIVE-CARE

Existing scoring systems have failed to reflect the pathophysiological changes during ICU therapy, and do not provide reliable criteria for the prediction of outcome in surgical patients. The aim of the present project was to establish a comprehensive scoring system for dally eva luation of physiological parameters and therapeutic interventions in a surgical intensive care unit, and to identify score patterns in the c ourse of ICU treatment to be used for prospective clinical decisions. In a prospective study of 123 consecutive patients who required intens ive care for more than two consecutive days we documented 10 physiolog ical parameters and a set of 14 therapeutic interventions on a daily b asis over a to: tal of 1274 days. Evaluation of the new scoring system , called the Heidelberg Intensive Ward Score (HDWS), included comparis on with APACHE II and a set of unfavorable HDWS-patterns at different time points during ICU treatment. All variables were implemented into a notebook computer to be used at bedside. Neither HDWS nor APACHE II obtained on admission differentiated between survivors and non-survivo rs. In contrast, scores of non survivors were significantly higher tha n scores of survivors at day 7. At that point, HDWS was superior to AP ACHE II with respect to the predictive power as assessed by receiver o perator characteristic curves. No patient who fulfilled all four unfav orable HDWS-patterns during the first week of ICU treatment survived ( but these were only two patients). We conclude that the limited power of scores obtained on admission to predict outcome in surgical patient s may be improved by trend analysis of scores over time which also tak e into account the patients' response to therapy. The Heidelberg Inten sive Ward Score is a first step in the development of such a dynamic m odel which may also allow for the definition of individual outcome cri teria in the near future.