The SISVistA Investigators of the Veterans Administration developed a computerized intensive care unit (ICU) risk adjustment tool. One component is a total laboratory score modeled on the APACHE III. The authors are from multiple universities and VA hospitals in Cincinnati, Indianapolis and St Louis.
Parameters:
(1) age
(2) PaCO2 and pH
(3) serum sodium in mmol/L (mEq/L)
(4) serum total bilirubin in mg/dL
(5) serum creatinine in mg/dL
(6) hematocrit in percent
(7) PaO2 to FIO2 ratio
(8) serum albumin in g/dL
(9) blood urea nitrogen in mg/dL
(10) blood glucose in mg/dL
(11) white blood cell count per µL
|
PaCO2 in mm Hg |
pH |
Points |
|---|---|---|
|
< 30 |
< 7.2 |
12 |
|
|
7.2 to 7.3 |
9 |
|
|
7.31 to 7.5 |
5 |
|
30 to 45 |
< 7.2 |
12 |
|
|
7.2 to 7.3 |
NA |
|
|
7.31 to 7.45 |
0 |
|
45 to 50 |
< 7.2 |
12 |
|
|
7.2 to 7.3 |
3 |
|
|
7.31 to 7.45 |
1 |
|
> 50 |
< 7.2 |
4 |
|
|
7.2 to 7.3 |
2 |
|
|
> 7.3 |
NA |
where:
• There were several gaps in the possible combinations of PaCO2 and pH.
• The combination of PaCO2 > 50 and pH > 7.3 is probably unlikely.
• In the implementation I will use 6 points for the combination of PaCO2 30-45 mm Hg and pH 7.2 to 7.3 since it is midway between 9 and 3.
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
< 45 years |
0 |
|
|
45 - 59 years |
5 |
|
|
60 - 64 years |
11 |
|
|
65 - 69 years |
13 |
|
|
70 - 74 years |
16 |
|
|
75 - 84 years |
17 |
|
|
> 84 years |
23 |
|
serum sodium |
< 120 mmol/L |
3 |
|
|
120 - 134 mmol/L |
2 |
|
|
135 - 154 mmol/L |
0 |
|
|
> 154 mmol/L |
4 |
|
serum total bilirubin |
< 2.0 mg/dL |
0 |
|
|
2.0 - 2.9 mg/dL |
5 |
|
|
3.0 - 4.9 mg/dL |
6 |
|
|
5.0 - 7.9 mg/dL |
8 |
|
|
> 7.9 mg/dL |
16 |
|
serum creatinine |
< 0.4 mg/dL |
3 |
|
|
0.4 - 1.5 mg/dL |
0 |
|
|
1.51 - 1.94 mg/dL |
4 |
|
|
> 1.94 mg/dL |
7 |
|
hematocrit in percent |
< 40.9% |
3 |
|
|
40.9 - 49% |
0 |
|
|
>= 50% |
3 |
|
PaO2 to FIO2 ratio |
> 350 |
0 |
|
|
300 - 350 |
2 |
|
|
250 - 299 |
5 |
|
|
200 - 249 |
7 |
|
|
150 - 199 |
11 |
|
|
101 - 149 |
15 |
|
|
<= 100 |
20 |
|
serum albumin |
< 2.0 g/dL |
11 |
|
|
2.0 - 2.4 g/dL |
6 |
|
|
2.5 - 4.4 g/dL |
0 |
|
|
> 4.4 g/dL |
4 |
|
BUN |
< 17 mg/dL |
0 |
|
|
17 - 19 mg/dL |
2 |
|
|
20 - 39 mg/dL |
7 |
|
|
40 - 79 mg/dL |
11 |
|
|
> 79 mg/dL |
12 |
|
blood glucose |
< 40 mg/dL |
19 |
|
|
40 - 59 mg/dL |
18 |
|
|
60 - 199 mg/dL |
0 |
|
|
200 - 349 mg/dL |
3 |
|
|
> 350 mg/dL |
5 |
|
white blood cell count |
< 1,000 per µL |
19 |
|
|
1,000 - 2,900 per µL |
5 |
|
|
3,000 - 19,900 per µL |
0 |
|
|
20,000 - 24,900 per µL |
1 |
|
|
> 24,900 per µL |
5 |
where:
• The blood glucose could be serum or plasma rather than whole blood.
• Some of the point assignments (for example, serum albumin and WBC) are unexpected.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 146
• The higher the score the worse the clinical outcome.
|
Total Score |
Mortality Rate |
|---|---|
|
0 to 19 |
1.2% |
|
20 to 39 |
7.5% |
|
>= 40 |
26.2% |
Specialty: Critical Care, Emergency Medicine
