Cattermole et al developed the THERM (THE Resuscitation Management) score for identifying a critically-ill patient in the Emergency Department. This can help to identify a patient who may benefit from more aggressive management. The authors are from Princess Royal Hospital (London), Canberra Hospital and the Chinese University of Hong Kong.
Patient selection: patient in the emergency department
Outcome: poor if death or admission to the ICU within 7 days of ED attendance
Parameters:
(1) Glasgow Coma Score (GCS)
(2) serum bicarbonate in mmol/L
(3) systolic blood pressure
Parameter
Finding
Points
Glasgow Coma Score
from 3 to 15
<GCS>
serum bicarbonate
MAX(22, <bicarbonate>)
systolic blood pressure
>= 100 mm Hg
0
< 100 mm Hg
-4
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: determined by lowest physiologic value for serum bicarbonate
• maximum score: 37
• The higher the score the better the prognosis.
Score
Risk Group
Poor Outcome
35.1 to 37
low
3%
30.1 to 35
medium
20%
<= 30
high
50%
Performance:
• The area under the ROC curve is 0.84.
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