Risk Stratification and ICU Scoring Correlated To Quality of Care in the Critically Ill Patient

Abstract

Critical illness causes profound pathophysiological changes in almost all organ function, particularly the cardiovascular, respiratory, renal and hepato-billiary systems. Both the neuroendocrine and immune systems interact with molecular pathways that contribute to neuropsychiatric and muscular systems changes which leads to functional impairments resulting in important adverse outcomes among survivors of critically ill patient. Assessment and early recognition of critically ill patients in systematic approach is essential and leads to early treatment and improvement of prognosis. Scoring systems used in critically ill patients can be broadly divided into those that are specific for an organ or disease (for example, the Glasgow Coma Scale (GCS) and FOUR score in comatosed patient, Berlin Criteria in ARDS, Child-Pugh classification, MELD score and KCC for liver diseases, RIFLE and AKIN Criteria for AKI and ISTH Diagnostic Scoring System for DIC) and those that are general for all ICU patients. The general scores can broadly be divided into mortality prediction systems for example: (APACHE I, II, III, and IV), (SAPS I, II and III), and Mortality Probability Model (MPM I, II and III), morbidity prediction systems (for example: MODS, SOFA and LODS scores). It is to be emphasized that scoring systems were developed in groups of patients and should not replace individualized patient care and decision making in the ICU. Garnering maximal value from scoring system data requires in-depth knowledge of how these scoring systems behave in different populations, and how care changes over time.