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Ressources et utilitaires

Scoring systems for ICU and surgical patients:

Portsmouth - POSSUM
(Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity) 

Age <= 60 61 - 70 >= 71	Glasgow (Help) 15 12 - 14 9 - 11 < or = 8	Respiratory (1pt) No dyspnoea (2pts) Dyspnoea on exertion (2pts) Mild COPD on chest RX (4pts) Limiting dyspnoea (1 flight) (4pts) Moderate COPD on chest RX (8pts) Dyspnoea on rest (F>=30/') (8pts) Fibrosis or Consolidation
Urea < or = 7.5 mmol/L 7.6-10 mmol/L 10.1-15 mmol/L >or= 15.1 mmol/L	Pulse (beats/min) < or = 39 < 40-49 50-80 81-100 101-120 > or = 121	Cardiac signs (1pt) No failure (2pts) Diuretics, digoxin (2pts) Antianginal Antihypertensive (4pts) Peripheral oedema / Warfarine (4pts) Borderline cardiomegaly (8pts) Raised Jugular venous Press. (8pts) Cardiomegaly
Hb (g/dL) < or = 9.9 10-11.4 11.5-12.9 13-16 16.1-17 17.1-18 > or = 18.1	W.B.C. < or = 3000/ mm3 3100-3999 /mm3 4000-10000/mm3 10100-20000/mm3 > or = 20100/mm3	ECG (1pt) Normal (4pts) AF + Rate = 60-90 (8pts) Anyother abnormal rythm (8pts) 5 or more EVS/min (8pts) Q Waves or ST-T changes
Potassium (mEql/L) < or = 2.8 2.9-3.1 3.2-3.4 3.5-5.0 5.1-5.3 5.4-5.9 > or = 6.0	Sodium (mEql/L) < or = 125 126-130 131-135 > or = 136	Systolic Blood Pressure < or = 89 mmHg 90-99 mmHg 100-109 mmHg 110-130 mmHg 131-170 mmHg > or = 171 mmHg
Physiologic Score

Operative Severity (Help) Minor Moderate Major Major +	Multiple procedures 1 2 > 2	Total Blood Loss < or = 100 mL 101-500 mL 501-999 mL > or = 1000 mL
Peritoneal soiling None Minor (serous fluid) Local pus free bowel cont.pus or blood	Cancer None Primary only Nodal metastases. Distant metastases	Mode of surgery Elective Emergency (Possibly > 2H) Surgery< 24 H after adm. Emergency (< 2H needed)
Operative Score

Predicted Death Rate

R= (0.1692 * physiologic score)+(0.1550 *operative score)-9.065 Predicted Death Rate = 1 / ( 1+ e(-R) )

References :

Copeland GP et al. POSSUM : a scoring system for surgical audit. Br J Surg. 1991;78:356-360.
Prytherch DR et al. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg. 1998;85:1217-20

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Moderate surgery : cholecystectomy, appendicectomy, mastectomy, transurethral resection of prostate
Major surgery : any laparotomy , bowel resection, cholecystectomy with choledochotomy, peripheral vascular procedure or major amputation
Major surgery + : any aortic procedure, abdominoperineal resection, pancreatic or liver resection, oesophagogastrectomy.

Eyes Open	Verbal	Motor
Spontaneous To speech To pain Absent	Converses / Oriented Converses / Disoriented Inappropriate Incomprehensible Absent	Obeys Localizes pain Withdraws (flexion) Decorticate (flexion) rigidity Decerebrate (extension) rigidity Absent

Glasgow=

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