Hannover Intensive Score (HIS)

Is the patient an adolescent or adult in the Intensive Care Unit (ICU)?

Temperature

Are blood cultures positive?

WBC count

Platelet count

Glasgow coma score (enter from 3 to 15)

Does the patient have a positive Babinski sign?

Has the patient had convulsions?

Has the patient lost CNS regulatory functions?

Have any bowel anastomosis broken down?

Has there been a bowel perforation?

SGOT

SGPT

Bilirubin

Serum amylase

Does the patient have clinical evidence of cirrhosis?

Is the patient jaundiced?

Quick test (enter from 0 to 100)

Is consumptive coagulopathy (DIC) present?

PTT

Antithrombin III of normal (enter from 0 to 200)

Has the patient received coagulation factor replacement therapy?

Glucose

Heart rate

Systolic blood pressure

Has the patient required resuscitation (CPR)?

Infusion dose of dopamine

Is the patient receiving infusions of catecholamines?

Does the patient have a ventricular or supraventricular tachycardia?

Does the patient have an atrial arrhythmia?

Is the patient receiving anti-arrhythmic agents?

Creatinine clearance

Is the patient being dialyzed?

Serum creatinine

BUN

Is the patient receiving diuretics?

Is the patient uremic?

Does the patient have gross hematuria?

Serum potassium

Has the patient had a pneumothorax?

Have chest drainage tubes been placed?

Is the patient receiving PEEP or CPAP?

Pressure of water

FIO2 as a decimal (from 0.21 to 1.00)

CNS function

Intestinal function

Urine output

Respiratory function