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Intensivmedizinische Scoringsysteme zur täglichen Anwendung

Übersicht, aktuelle Möglichkeiten und Anforderungen an Neuentwicklungen

Scoring systems for daily assessment in intensive care medicine

Overview, current possibilities and demands on new developments

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Zusammenfassung

Scoringsysteme sind fester Bestandteil moderner Diagnostik, in der Qualitätssicherung und in das „Diagnosis-related-groups“- (DRG-)Entgeltsystem integriert. Die fortwährenden Neu- und Weiterentwicklungen lassen eine Gliederung nach dem Anwendungscharakter sinnvoll erscheinen, um den Überblick über die zahlreichen Systeme zu behalten. Im Bereich der Intensivmedizin lassen sich die Scoringsysteme in Aufnahme- und Verlaufsscores unterteilen. Hierbei können die täglich zu erfassenden Instrumente, je nach Zielkriterium, in fünf weitere Gruppen kategorisiert werden: objektive Beschreibung des Grades der Organdysfunktion, Verlaufsbeschreibung während der Intensivtherapie, Einschätzung der Pflegeaufwendigkeit, Bestimmung des Outcomes/Mortalitätsrisikos und Gruppierung von Patientenkollektiven für Studienzwecke. Bei zukünftigen Entwicklungen wird es notwendig sein, neue Strategien zu entwickeln, um den Krankheitsverlauf eines Patienten adäquat darstellen zu können. Nicht nur die Mortalität als Zielparameter wird dabei infrage gestellt werden müssen, sondern auch der Umgang mit fehlenden Messwerten und der bislang praktizierten Vereinfachung der Realität durch Kategorisierung, die sich in allen etablierten Scoringsystemen bis hin zur Berechnung prädiktiver, auf ein bestimmtes Ereignis bezogener Werte findet.

Abstract

Scoring systems are a fixed element of modern diagnostics and are integrated in the diagnosis-related groups (DRG) billing system as well as quality assurance projects. The ongoing developments require classification according to the terms of use in order to maintain an overview of the numerous systems available. In the area of intensive care medicine scoring systems can be divided into admission scores and progress scores, whereby the scores for daily assessment can be further subdivided into five categories, depending on the target criteria: objective description of the grade of organ dysfunction, progression in intensive care therapy, evaluation of the degree of nursing care, determination of outcome/mortality risk, and grouping of patient collectives for clinical trials. In future developments it will be necessary to generate new strategies to adequately describe the progress of a patient. Not only will mortality be challenged as a target criterion but also the handling of missing data and the simplification of reality by categorization practised so far that can be found in all established scoring systems as far as calculation of predictive values regarding a defined result.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Herr Dr. Florian Brenck wird im Rahmen einer Sachbeihilfe der Deutschen Forschungsgemeinschaft (Fördernummer DFG JU 464/1–1) unterstützt.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland

    F. Brenck,  B. Hartmann & M. Mogk

  2. Department of Anesthesiology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Canada

    A. Junger

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  1. F. Brenck
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  2. B. Hartmann
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  4. A. Junger
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Correspondence to B. Hartmann.

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Brenck, F., Hartmann, B., Mogk, M. et al. Intensivmedizinische Scoringsysteme zur täglichen Anwendung. Anaesthesist 57, 189–195 (2008). https://doi.org/10.1007/s00101-007-1299-1

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