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Scoring systems for ICU and surgical patients:

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 Morbidity Rate (Definitions are following)	Predicted Mortality Rate
x = (0.16* physiologic score)+(0.19*operative score)- 5.91 Predicted Morbidity Rate = 1/(1+ e(-x))	y = (0.13* physiologic score)+(0.16*operative score)-7.04 Predicted Mortality Rate = 1/(1+ e(-y))

 

Ref : Copeland GP et al. POSSUM : a scoring system for surgical audit. Br J Surg. 1991;78: 356-60. 

 

Morbidity : definitions 

Wound haemorrhage : local haematoma requiring evacuation.
Deep haemorrhage: postoperative bleeding requiring re-exploration.
Chest infection: production of purulent sputum with positive bacteriological cultures, with or without chest radiography changes or pyrexia, or consolidation seen on chest radiograph.
Wound infection : wound cellulitis or the discharge of purulent exsudate.
Urinary infection: the presence of > 10 ⁵ bacteria / ml with the presence of withe cells in the urine, in previously clear urine.
Deep infection: the presence of an intra-abdominal collection confirmed clinically or radiologically.
Septicaemia : positive blood culture.
Pyrexia of unknown origin : any temperature above 37° C for more than 24 h occuring after the original pyrexia following surgery (if present) had settled , for which no obvious cause could be found.
Wound dehiscence : superficial or deep wound breakdown.
Deep venous thrombosis and pulmonary embolus : when suspected, confirmed radiologically by venography or ventilation/ perfusion scanning or diagnosed at post mortem.
Cardiac failure : symptoms or signs of left ventricular or congestive cardiac failure ( alteration from preoperative measures)
Impaired renal function : arbitrarily defined as an increase in blood urea of > 5 mmol / l from preoperative levels .
Hypotension : a fall in systolic blood pressure below 90 mmHg for more than 2 H as determined by sphygmomanometry or arterial pressure transducer measurement
Respiratory failure : respiratory difficulty requiring emergency ventilation.
Anastomotic leak : discharge of bowel content via the drain, wound or abnormal orifice.

 

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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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