Hannover Intensive Score (HIS) Patient Assessment - Medical Algorithm

Description

The Hannover Intensive Score can be used to assess patients in the intensive care unit (ICU). This can help identify those patients who might benefit from more aggressive therapy, and it can be used to compare outcomes between different institutions.

NOTE: This is based on my translation from the German. I did not have a medical dictionary at the time of translation, so some nuances may have been lost as well as some outright errors introduced.

Patient population:

(1) I believe this applies to adults and not neonates or small children.

(2) The score was developed in a large series of patients admitted to an ICU at an academic center in Hannover, Germany.

Evaluation can be performed on the first day in the ICU, after 1 week, and after 2 weeks.

Major functions assessed to derive score:

(1) immunologic and hematologic: temperature, WBC count, platelet count

(2) cerebral: level of consciousness, Glasgow Coma Score

(3) gastrointestinal: intestinal status, liver function, prothrombin time (Quick test), PTT, antithrombin III level, blood glucose

(4) cardiovascular: Shock Index, pulse, arrhythmias

(5) renal: creatinine clearance, serum creatinine, urea or BUN, urine output, serum potassium

(6) respiratory: ventilatory status, use of PEEP or CPAP, FIO2

Parameter	Finding	Points	Supplemental
temperature (°C)	< 34.0	2
	34.0 - 36.4	1
	36.5 - 38.4°C	0
	38.5 - 38.9	1
	39.0 - 40.9	2
	>= 41	3
	positive blood culture		+1
WBC	< 3,000 per µL	2
	3,000 - 14,900	0
	15,000 - 19,900	1
	20,000 - 29,900	2
	>= 30,000	3
platelet count	< 120,000 per µL		+1
CNS	conscious, responds to verbal commands	0
	responds to pain but does not responds to verbal commands	1
	does not respond to pain	2
	no reaction to pain, pupils do not react to light	3
	positive Babinski, convulsions, disturbances of central regulatory functions		+1
Glasgow coma score	13 - 15	0
	7 - 12	1
	4 - 6	2
	3	3
Intestine function	normal	0
	partial ileus	1
	ileus	2
	operation needed due to ileus; GI tract bleeding	3
	anastomosis insufficiency; bowel perforation		+1
liver function	normal	0
	SGOT, SGPT > 200 U bilirubin >= 1.1 mg/dL amylase > 500 U	1
	SGOT, SGPT > 1000 U evidence of cirrhosis jaundice	2
Quick test (%)	>= 50%	0
	20 - < 50%	1
	< 20%	2
	consumptive coagulopathy (DIC)		+1
PTT in seconds	<= 60 seconds	0
	> 60 seconds	1
antithrombin III in percent	>= 70%	0
	< 70%	1
	coagulation factor replacement therapy		+1
glucose in mmol/L	< 2 mmol/L		+1
	> 30 mmol/L		+1
shock index	<= 0.85	0
	0.86 - 0.99	1
	1.0 - 1.2	2
	> 1.2	3
	resuscitation performed		+1
pulse in beats/minute	< 40	3
	40 - 110	0
	111 - 140	1
	141 - 180	2
	> 180	3
	dopamine > 200 mg/day or catecholamines		+1
heart rhythm	ventricular tachycardia; supraventricular tachycardia; atrial arrhythmias; antiarrhythmic agents		+1
creatinine clearance	>= 100 mL/min	0
	50 - 99 mL/min	1
	< 50 mL/min	2
	dialysis	3
serum creatinine	< 2.3 mg/dL	0
	2.3 - 4.4 mg/dL	1
	4.5 - 7.8 mg/dL	2
	>= 7.9 mg/dL	3
"urea" (see below)	20 - 39 mg/dL	0
	>= 40 mg/dL	1
urine output	patient receiving diuretics	1
	oliguria	2
	polyuria	2
	uremia	3
	anuria	3
	gross hematuria		+1
serum potassium	<= 6 mEq/L	0
	> 6 mEq/L	3
respiration	spontaneous without assistance	0
	spontaneous breathing with assistance	1
	mechanical ventilation	2
	pneumothorax or thoracic drainage		+1
PEEP/CPAP	none	0
	<= 10 cm H2O	1
	> 10 cm H2O	2
FIO2	0.21	0
	0.22 - 0.40	1
	0.41 - 0.60	2
	> 0.60	3

where:

• I translated Streckkrampfe and Zerebr. Krampfe as seizures

• I translated Platzbauch as "bowel perforation"

• shock index = (heart rate) / (systolic blood pressure)

• I translated "VES" as "ventricular tachycardia"

• urea vs BUN: I believe "serumharnstoff" translates to urea, but when looking at the point assignment, values for BUN made more sense than values for urea (the value I got for BUN corresponding to a urea of 40 mg/dL was pretty low), Only 1 point is assigned for this, so a small error seemed acceptable. For serious usage, this needs to be checked.

• The use of values for SGOT, SGPT, bilirubin and amylase without knowing the reference range could introduce error, but the breakpoints seem to handle minor variations between institutions. If this system is to be seriously used, then finding the reference ranges used at Hannover would be indicated.

• The Quick test is the prothrombin time. The percent is read from a graph correlating prothrombin time vs the percent dilution of normal plasma (viz, a PT of 45 seconds is seen at an X% of normal plasma) .

HIS =

= SUM(points for parameters present)

Interpretation:

• minimum score: 0

• maximum score: 60

• The performance of HIS was found comparable to Apache II and TISS. It may be better for predicting outcome during longer admissions.

HIS Score	Mortality Rate
0-1	2%
2-3	5%
4-5	12%
6-7	25%
8-9	28%
10-11	36%
12-13	33%
14-15	55%
> 15	72%

approximated from Table 2, page 530, von Bierbrauer 1998

Limitations:

• Correlations between score and mortality rate will be affected by improved technologies.

Implementation Notes:

• When more than one item is present (in liver function tests, supplemental scores for CNS function, etc.) the options are to add one point if any one of the findings is present (OR function), or to add one point for each finding present (AND function). I have opted for the OR approach.

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Description

Specialty

Objective

ICD-10

Hannover Intensive Score (HIS)

Purpose: To use the Hannover Intensive Score to evaluate a patient in the Intensive Care Unit (ICU).

Description

Specialty

Objective

ICD-10