The Northern Division of the Transitional Health Authority in New Zealand introduced generic criteria for surgical priority. This was intended to use the clinical severity and ability to benefit to derive a score which could be used to rank surgical candidates before procedures. The following represents the second version of the criteria.
Clinical Severity
|
Parameter |
Finding |
Points |
|
suffering (physical or mental) |
none |
0 |
|
|
mild - occasional and low grade |
1 |
|
|
moderate - intermittent or low grade |
3 |
|
|
severe - frequent, in nighttime, or severe |
5 |
|
|
incapacitating - dominates life |
7 |
|
disability |
none |
0 |
|
|
normal activities difficult |
1 |
|
|
activities curtailed |
3 |
|
|
unable to fulfill work/family role |
5 |
|
|
unable to care for self |
7 |
|
clinical cost of delay |
poorer outcome following procedure |
1 |
|
|
progression to more major intervention |
3 |
|
|
high possibility of avoidable disability, illness or death |
6 |
clinical severity score =
= (points for suffering) + (points for disability) + (points for clinical cost of delay)
Interpretation:
• minimum score: 0
• maximum score: 20
Total Capacity to Benefit
|
Parameter |
Finding |
Points |
|
degree of improvement anticipated |
slight reduction in suffering/disability |
0 |
|
|
moderate reduction in suffering/disability |
1 |
|
|
major reduction in suffering/disability |
2 |
|
likelihood of improvement |
<25% gain significant improvement |
0 |
|
|
25-50% gain significant improvement |
1 |
|
|
51-90% gain significant improvement |
2 |
|
|
> 90% gain significant improvement |
3 |
total capacity to benefit score =
= (points for degree of improvement) + (points for likelihood of improvement)
Interpretation:
• minimum score: 0
• maximum score: 5
Calculation of the Total Score
total score =
= (clinical severity score) * (total capacity to benefit score)
Interpretation:
• minimum score: 0
• maximum score: 100
Limitations:
• Patients with benign diseases tend to have higher scores than patients with malignant diseases, largely due to the longer life expectancy and higher probability of seeing a benefit over time.
• The criteria apparently were derived without open clinical input and no validation studies have been published.
