Ressources et utilitaires

Scoring systems for ICU and surgical patients:

NTISS (Neonatal Therapeutic Intervention Scoring System) 


Respiratory
Subscore
Cardiovascular
Subscore
Supplemental oxygena
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 ventilationa
3
yes Volume expansion (>15 mL/kg)c
3
yes
Mechanical ventilation with muscle relaxationa
4
yes Vasopressor administration (1 agent)d
2
yes no
Hight-frequency ventilationa
4
yes Vasopressor administration (>1 agent)d
3
yes
Surfactant administration
1
yes no Cardiopulmonary resuscitation
4
yes no
Endotracheal intubation
2
yes no Pacemaker on standbye
3
yes no
Tracheostomy careb
1
yes no Pacemaker usede
4
yes
Tracheostomy placementb
1
yes  
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 agentsf
2
yes Phlebotomy ( 5-10 blood draws)h
1
yes no
Diuretic administration (enteral)g
1
yes no Extensive phlebotomy ( > 10 blood draws)h
2
yes
Diuretic administration (parenteral)g
2
yes 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
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 placej
2
yes no Central venous line
2
yes no
Multiple chest tubes in placej
3
yes
Thoracentesis
3
yes no
Pericardial tube in placel
4
yes no
Pericardiocentesisl
4
yes
Minor operation k
2
yes no
Major operation k
4
yes
 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.

 

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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