Schonenberger et al reported the SETscore for evaluating a patient with cerebrovascular disease in the intensive critical care unit. This can help to identify a patient who may require more aggressive management for a longer time. The authors are from the University of Heidelberg, National Neuroscience Institute Riyadh, and King Saud Bin Abdulaziz University for Health Sciences.
Patient: cerebrovascular disease in the ICU
Parameters:
(1) dysphagia
(2) observed aspiration
(3) Glasgow coma scale (GCS)
(4) brainstem lesion
(5) space-occupying cerebellar lesion
(6) ischemic infarct in middle cerebral artery territory
(7) intracerebral hemorrhage (ICH) volume
(8) diffuse lesion
(9) hydrocephalus
(10) neurosurgical intervention
(11) additional respiratory disease
(12) PaO2/FIO2
(13) acute physiology score (APS) from APACHE II
(14) lung injury score (LIS)
(15) sepsis
|
Parameter
|
Finding
|
Points
|
|
dysphagia
|
no
|
0
|
|
|
yes
|
4
|
|
observed aspiration
|
no
|
0
|
|
|
yes
|
3
|
|
GCS
|
10 to 15
|
0
|
|
|
3 to 9
|
3
|
|
brainstem lesion
|
no
|
0
|
|
|
yes
|
4
|
|
cerebellar lesion space occupying
|
no
|
0
|
|
|
yes
|
3
|
|
ischemic infarct
|
<= 2/3 MCA territory
|
0
|
|
|
> 2/3 MCA territory
|
4
|
|
ICH volume
|
<= 25 ml
|
0
|
|
|
> 25 mL
|
4
|
|
diffuse lesion
|
no
|
0
|
|
|
yes
|
3
|
|
hydrocephalus
|
no
|
0
|
|
|
yes
|
4
|
|
neurosurgical intervention
|
no
|
0
|
|
|
yes
|
2
|
|
additional respiratory disease
|
no
|
0
|
|
|
yes
|
3
|
|
PaO2/FIO2
|
>= 150
|
0
|
|
|
< 150
|
2
|
|
APS
|
<= 20
|
0
|
|
|
> 20
|
4
|
|
LIS
|
<= 1
|
0
|
|
|
> 1
|
2
|
|
sepsis
|
no
|
0
|
|
|
yes
|
3
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 48
• A score >= 8 is associated with tracheostomy and a prolonged ICU stay.
Performance:
• The area under ROC curve is 0.80 for prolonged ventilation.
