Gray JE, Richardson DK et al. Neonatal Therapeutic Intervention Scoring System : a therapy-based severity-of-illness index. Pediatrics. 1992;90:561-7.
NEONATAL THERAPEUTIC INTERVENTION
SCORING SYSTEM (NTISS)
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
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.
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.