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Risk Score of de Lassence et al for Iatrogenic Pneumothorax in the Intensive Care Unit (ICU)

Purpose: To evaluate a patient in the intensive care unit (ICU) for the risk of iatrogenic pneumothorax as reported by de Lassence et al.

Description

De Lassence et al developed a risk score for predicting iatrogenic pneumothorax in the Intensive Care Unit (ICU). These can help identify patients who may benefit from closer monitoring or preventive measures. The authors are from multiple ICUs across France and are members of the OUTCOMEREA Study Group.


Parameters:

(1) body weight in kilograms

(2) history of AIDS

(3) diagnosis on ICU admission

(4) need for inotropic support during the first 24 hours after admission to the ICU

(5) central catheter during the first 24 hours after admission to the ICU

 

Parameter

Finding

Points

body weight

< 80 kilograms

1

 

>= 80 kilograms

0

history of AIDS

no

0

 

yes

1

diagnosis on ICU admission

ARDS

2

 

cardiogenic pulmonary edema

1

 

other

0

inotropic support during first 24 hours

none

0

 

present

1

central line (central venous, pulmonary artery) in first day

absent

0

 

present

1

 

where:

• In Table 3 body weights are < 80 kilograms and > 80 kilograms. However, The data in Table 2 indicates risk is associated with a weight < 80 kg.

• Mechanical ventilation was the most common precipitating factor for pneuothorax in the series (page 9).

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• The higher the score the greater the risk of iatrogenic pneumothorax.

• The risk also increases the longer the person is in the ICU.

 

Total Score

Risk of Pneumothorax at 2 Weeks in ICU

Risk of Pneuomthorax at 1 Month in ICU

0

 

< 1%

1 or 2

0.6%

1.2%

3 or 4

3%

6%

5 or 6

6%

12%

from Figure 3, page 11, for validation group (B)


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Specialty

Objective

ICD-10