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Scoring Systems in Critical Care

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Pediatric Critical Care Medicine

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Abstract

Today’s health care environment is focused on providing both high quality and error-free care. Transparency is becoming an expectation, with many outcomes reported publically. Scoring systems are an objective measure which can be used to assess quality of care, assist with the evaluation and modification of complex systems of care, improve patient outcomes and predict morbidity and mortality. Their role has become secure in critical care because physician’s judgments are too subjective for quality assessment in large samples.

The development of scoring systems began as external influences in the 1960s favored the assessment of outcome. Concerns about the quality of medical care escalated following the Institute of Medicine Report in 1999 which ultimately led to the Patient Safety and Quality Improvement Act of 2005. A successful scoring system must include a model with carefully defined predictor variables and outcome. The model must be reliable and the scoring system requires both internal and external validation.

Scoring systems were developed to predict mortality in adults (APACHE: Acute Physiology and Chronic Health Evaluations Score) and children (PRISM: Pediatric Risk of Mortality Score). They have also been used to predict morbidity and functional outcome. Scoring systems that apply to specific patient populations such as trauma and congenital heart disease have been developed.

Clinical scoring systems provide a standardized method for intensive care benchmarking and have increased in number and utility over the past 30 years. They are progressively more applicable to clinicians and health services researchers and in the future may be pertinent to individual patients. It is in the intensivist’s best interest to understand scoring systems, their applications and implications.

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Author information

Authors and Affiliations

  1. Critical Care Medicine, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA

    Sandra D. W. Buttram MD & Paul R. Bakerman MD

  2. Department of Child Health, University of Arizona College of Medicine – Phoenix, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA

    Murray M. Pollack MD

Authors
  1. Sandra D. W. Buttram MD
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  2. Paul R. Bakerman MD
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  3. Murray M. Pollack MD
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Corresponding authors

Correspondence to Sandra D. W. Buttram MD or Murray M. Pollack MD .

Editor information

Editors and Affiliations

  1. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Buttram, S.D.W., Bakerman, P.R., Pollack, M.M. (2014). Scoring Systems in Critical Care. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6362-6_6

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  • DOI: https://doi.org/10.1007/978-1-4471-6362-6_6

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