Ressources et utilitaires

Scoring systems for ICU and surgical patients:

System 97 (Predictive score for acquired adult heart surgery) 

Preoperative risk factors	Logistic regression model		Bedside approximation score
	eValue : 1 if yes, 0 otherwise	Beta
Age	< 70 70 - 74 75 - 79 > 79		< 70 70-74 75-79 > 79
Female gender	Yes		Yes No
Diabetes mellitus	Yes		Yes No
Congestive heart failure	Yes		Yes No
Left mainstem stenosis >= 50 %	Yes		Yes No
COPD	Yes		Yes No
Pulmonary hypertension	Yes		Yes No
Peripheral vascular disease	Yes		Yes No
Morbid obesity (> 1.5 ideal weight)	Yes		Yes No
Preoperative IABP	Yes		Yes No
Aortic valve : replacement	Yes
Aortic valve : regurgitation (endocarditis)	Yes
CABG added to valve surgery	Yes		Yes No
Neurologic disorder	Yes		Yes No
Hypertension (> 140/90 mmHg)	Yes		Yes No
Left ventricular ejection fraction	EF >= 50% EF 30 - 49% EF< 30%		< 30 % 30-49 % > 50 %
Cardiomegaly	Yes		Yes No
Reoperation	First Second +		Yes, first Yes, secondNo
Neoplasm, active	Yes
Acute MI within 48 h	Yes		Yes No
Renal failure	Yes		Yes No
Left ventricular aneurysm to be resected	Yes		Yes No
Ventricular tachycardia or fibrillation	Yes		Yes No
Mitral : valve replacement	Yes		Yes No
Mitral : acute regurgitation	Yes
Carotid disease	Unilateral Bilateral		Yes (uni or bilateral) No
Asthma	Yes		Yes No
Failed PTCA	Yes		Yes No
Substance abuse	Yes		Yes No
Cardiogenic shock	Yes		Yes No
Pacemaker dependency	Yes
Cold agglutinins	Yes
Abdominal aortic aneurysm present	Yes		Yes No
Intubated	Yes		Yes No
Dialysis dependency	Yes		Yes No
Endocarditis	Treated Untreated, active		Treated Active No
Tricuspid valve replacement	Yes		Yes No
Cirrhosis	Yes		Yes No
Ideopathic, thrombogenic purpura	Yes		Yes No
Blood products refused	Yes		Yes No
AIDS	Yes		Approximation Score = (Help below)
(Definitions of the risk factors are not available in the referenced paper)	Logit = - 5.1850 + sum (values * beta) Predicted death rate within 30 days = 1 / (1 + e-Logit)
	Predicted death rate =

Ref : Bernstein AD, Parsonnet V. Bedside estimation of risk as an aid for decision making in cardiac surgery. Ann Thorac Surg. 2000;69:823-8.

 

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Approximation Score : "The logistic regression model described above was simplified to facilitate the rapid approximation of preoperative risk ... All coefficients were rounded to the nearest half-integer and multiplied by 10, and some infrequent risk factors with negative coefficients ( which occur rarely ) were omitted.
Two covariates with negative coefficients were assigned new weights on an empirical basis: refusal of blood products and repair of a ventricular defect were adjudged of equivalent risk to pulmonary hypertension and cardiogenic shock....
These empirical adjustments, based on clinical experience, were made only in low-prevalence covariates whose logistic regression coefficients had large standard errors."

 

 

Use the total score (bedside approximation) to read the estimated preoperative risk range from this plot, which shows the estimated risk of mortality together with 95% confidence limit.

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