Ressources et utilitaires

Scoring systems for ICU and surgical patients:

NTISS (Neonatal Therapeutic Intervention Scoring System)

Respiratory	Subscore			Cardiovascular	Subscore
Supplemental oxygen^a	1	yes	no	Indomethacin administration	1	yes	no
C.P.A.P.^a	2	yes		Volume expansion (<=15 mL/kg)^c	1	yes	no
Mechanical ventilation^a	3	yes		Volume expansion (>15 mL/kg)^c	3	yes	no
Mechanical ventilation with muscle relaxation^a	4	yes		Vasopressor administration (1 agent)^d	2	yes	no
Hight-frequency ventilation^a	4	yes		Vasopressor administration (>1 agent)^d	3	yes	no
Surfactant administration	1	yes	no	Cardiopulmonary resuscitation	4	yes	no
Endotracheal intubation	2	yes	no	Pacemaker on standby^e	3	yes	no
Tracheostomy care^b	1	yes	no	Pacemaker used^e	4	yes	no
Tracheostomy placement^b	1	yes	no
Extracorporeal membrane oxygenation	4	yes	no
Drug therapy				Monitoring
Antibiotic administration (<= 2 agents)^f	1	yes	no	Frequent vital signs	1	yes	no
Antibiotic administration (> 2 agents^f	2	yes	no	Phlebotomy ( 5-10 blood draws)^h	1	yes	no
Diuretic administration (enteral)^g	1	yes	no	Extensive phlebotomy ( > 10 blood draws)^h	2	yes	no
Diuretic administration (parenteral)^g	2	yes	no	Cardiorespiratory monitoring	1	yes	no
Anticonvulsant therapy	1	yes	no	Thermoregulated environment	1	yes	no
Aminophylinne administration	1	yes	no	Noninvasive oxygen monitoring	1	yes	no
Other unscheduled medication	1	yes	no	Arterial pressure monitoring	1	yes	no
Steroid administration (postnatal)	1	yes	no	Central venous pressure monitoring	1	yes	no
Potassium binding resin administration	3	yes	no	Urinary catheter	1	yes	no
Treatment of metabolic acidosis	3	yes	no	Quantitative intake and output	1	yes	no
Metabolic / nutrition				Transfusion
Gavage feeding	1	yes	no	Intravenous gamma globulin	1	yes	no
Phototherapy	1	yes	no	Double volume exchange transfusion	3	yes	no
Intravenous fat emulsion	1	yes	no	Partial volume exchange transfusion	2	yes	no
Intravenous amino acid solution	1	yes	no	Red blood cell transfusion (<=15 ml/kgⁱ	2	yes	no
Insulin administration	2	yes	no	Red blood cell transfusion (>15 ml/kg)ⁱ	3	yes	no
Potassium infusion	3	yes	no	Platelet transfusion	3	yes	no
				White blood cell transfusion	3	yes	no
Procedural				Vascular access
Transport of patient	2	yes	no	Peripheral intravenous line	1	yes	no
Dialysis	4	yes	no	Arterial line	2	yes	no
Single chest tube in place^j	2	yes	no	Central venous line	2	yes	no
Multiple chest tubes in place^j	3	yes	no
Thoracentesis	3	yes	no
Pericardial tube in place^l	4	yes	no
Pericardiocentesis^l	4	yes	no
Minor operation ^k	2	yes	no
Major operation ^k	4	yes	no
NTISS = SUM (points for activities performed) = Abstraction guidelines

Superscript letters represent mutually exclusive variables.

Reference

Gray JE, Richardson DK et al. Neonatal Therapeutic Intervention Scoring System : a therapy-based severity-of-illness index. Pediatrics. 1992;90:561-7.

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NEONATAL THERAPEUTIC INTERVENTION SCORING SYSTEM (NTISS)
Abstraction guidelines

The Neonatal Therapeutic Intervention Scoring System (NTISS) (1) is a therapy-based severity of illness assessment index. It is a modification of the TISS score of Cullen et al (2, 3) suitable for use in neonatal intensive care. NTISS measures severity by quantifying the intensity and complexity of care received by a patient. It is based on the assumption that given similar philosophies or styles of care, that therapeutic intensity is a direct correlate of illness severity.

NTISS scores the most intense level for each therapy during a 24 hour scoring period, thus some scoring categories are mutually exclusive. The first scoring period begins at the time of admission (i.e.: time of first vital signs), although other 24 hour scoring periods may be feasible. When scores are computed for sequential days, attention must be paid to whether scoring is based on initiation of a therapy or simply the presence/continuation of the therapy.

For simplicity in data collection, each of the NTISS variables is a binary term i.e. it can assume one of two values [Present or Absent]. The NTISS requires that portions of the chart other than the NICU flow sheet be scanned. The Nursing and Physician Progress notes may contain valuable information regarding the performance of procedures. In the final calculations of scores for NTISS, points are assigned only for the most intense intervention in a therapeutic category. Take for example, a patient who began a scoring period on supplemental oxygen by hood and then was placed on nasal CPAP, followed by endotracheal intubation and mechanical ventilation with muscle relaxation. In the final score, this patient would receive points only for mechanical ventilation with muscle relaxation because it is the most intense (i.e. the highest point score) respiratory therapy that she received within the respiratory category. In completing the scoring period data sheet, however, each of the three respiratory therapies listed above should be marked as present. In this way, maximal information is accumulated about each patient's hospital course.

James E. Gray, MD, SM. January 1996

References

1. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann D. Neonatal Therapeutic Intervention Scoring System (NTISS) : a therapy-based severity-of-illness index. Pediatrics, 1992;90:561-7.
2. Cullen DJ, Civetta JM, Briggs BA, et al. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med, 1974;2:57-60.
3. Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: Update 1983. Crit Care Med 1983;11:1-3.

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