Index of Coexistent Disease (ICED)

 

Conditions or limitations:

(1) ischemic heart disease

(2) congestive heart failure

(3) arrhythmias

(4) other heart disease

(5) hypertension

(6) cerebrovascular disease

(7) peripheral vascular disease

(8) diabetes mellitus

(9) respiratory disease

(10) malignancy

(11) hepatobiliary disease

(12) arthritis

(13) gastrointestinal disease

(14) circulation

(15) respiration

(16) neurologic function

(17) mental function

(18) urinary elimination

(19) bowel elimination

(20) feeding

(21) ambulation

(22) transfer

(23) vision

(24) hearing

(25) speech

 

where:

• Some items (circulation, respiration) seem duplications of other items (peripheral vascular disease, respiratory disease).

 

Disease Severity	Index of Disease Severity (IDS)
none (condition absent)	0
little or no morbidity	1
symptomatic; condition active but controlled; requires ongoing treatment	2
moderate to severe manifestations despite treatment	3

from Table 1, page 321

 

Impairment	Index of Physical Impairment (IPI)
none, normal function	0
mild to moderate impairment; may need assistance with activities of daily living	1
severe impairment	2

from Table 1, page 321

 

IDS	IPI	ICED Score
0	NA	0 (normal)
1 or 2	0	1 (mild)
1 or 2	1	2 (moderate)
3	0 or 1	3 (severe)
1, 2 or 3	2	3 (severe)

from Figure 1, page 322

 

Although this is an impressive matrix, it can be compressed into the following:

 

Condition or Impairment	ICED Score
moderate or severe despite therapy	3
severe impairment	3
mild to moderate impairment	2
mild or controlled condition without impairment	1

 

Greenfield et al found that the ICED correlated with postoperative complications after total hip replacement as well as 1 year functional status.

 

ICED	Rate of Postoperative Complications
0	2.9%
1	8.4%
2	16.3%
3	41.2%

Table 2, page 147

 

I am not certain if it is feasible to combine multiple minor conditions into a higher score, but this may not be necessary if the overall degree of impairment is considered.