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Scoring systems for ICU and surgical patients:

TISS (TISS - 76) (Therapeutic Intervention Scoring System - Update 1983)


4 points 3 points
a. Cardiac arrest and/or countershock within past 48 h yesno a. Central iv hyperalimentation (includes renal, cardiac, hepatic failure fluid) yesno
b. Controlled ventilation with or without PEEP yesno b. Pacemaker on standby yesno
c. Controlled ventilation with intermittent or continuous muscle relaxants yesno c. Chest tubes yesno
d. Balloon tamponade of varices yesno d. IMV or assisted ventilation yesno
e. Continuous arterial infusion yesno e. CPAP yesno
f. Pulmonary artery catheter yesno f. Concentrated K+ infusion via central catheter yesno
g. Atrial and/or ventricular pacing yesno g. Nasotracheal or orotracheal intubation yesno
h. Hemodialysis in unstable patient yesno h. Blind intratracheal suctioning yesno
i. Peritoneal dialysis yesno i. Complex metabolic balance (frequent intake and output) yesno
j. Induced hypothermia yesno j. Multiple ABG, bleeding, and/or STAT studies (> 4 shift) yesno
k. Pressure-activated blood infusion yesno k. Frequent infusion of blood products (>5 units /24 h) yesno
l. G-suit. yesno l. Bolus iv medication (nonscheduled) yesno
m. Intracranial pressure monitoring yesno m. Vasoactive drug infusion (1 drug) yesno
n. Platelet transfusion yesno n. Continuous antiarrythmia infusions yesno
o. IABP (Intra Aortic Balloon Pressure) yesno o. Cardioversion for arrythmia ( not defibrillation). yesno
p. Emergency operative procedures (within past 24 h) yesno p. Hypothermia blanket yesno
q. Lavage of acute GI bleeding yesno q. Arterial line yesno
r. Emergency endoscopy or bronchoscopy yesno r. Acute digitalization - within 48 h yesno
s. Vasoactive drug infusion (> 1 drug) yesno s. Measurement of cardiac output by any method yesno
  t. Active diuresis for fluid overload or cerebral edema yesno
u. Active Rx for metabolic alkalosis yesno
v. Active Rx for metabolic acidosis. yesno
w. Emergency thora-para and peri-cardiocenteses. yesno
x. Active anticoagulation (initial 48 h) yesno
y. Phlebotomy for volume overload yesno
z. Coverage with more than 2 iv antibiotics yesno
aa. Rx of seizures or metabolic encephalopathy (within 48 h of onset) yesno
bb. Complicated orthopedic traction yesno
2 points 1 point
a. CVP ( central venous pressure) yesno a. ECG monitoring yesnomn
b. 2 peripheral iv catheter yesno b. Hourly vitals signs yesno
c. Hemodialysis stable patient yesno c. 1 peripheral iv catheter yesno
d. fresh tracheostomy (less than 48 h) yesno d. Chronic anticoagulation yesno
e. Spontaneous respiration via endotracheal tube or tracheostomy (T-piece or trach mask) yesno e. Standard intake and output (q 24 h) yesno
f. GI feedings yesno f. STAT blood tests yesno
g. Replacement of excess fluid loss yesno g. Intermittent scheduled iv medications yesno
h. Parenteral chemotherapy yesno h. Routine dressing changes yesno
i. Hourly neuro vitals signs yesno i. Standard orthopedic traction yesno
j. Multiple dressing changes yesno j. Tracheostomy care yesno
 k. Pitressin infusion iv yesno k. Decubitus ulcer yesno
 TISS 76 = SUM (points for activities performed)=  Class = l. Urinary catheter yesno
m. Supplemental oxygen yesno
n. Antibiotics iv (2 or less) yesno
o. Chest physiotherapy yesno
p. Extensive irrigations, packings or debridement of wound, fistula or colostomy yesno
q. GI decompression yesno
r. Peripheral hyperalimentation / Intralipid therapy yesno
 

Classification

Class IV : >= 40 points
Class III : 20 - 39 points
Class II : 10 -19 points
Class I : < 10 points

TISS explanation code

4 Point Interventions : a) Point score for 2 days after more recent cardiac arrest. b) This does not mean intermittent mandatory ventilation wich is a 3-point intervention. It does mean that regardless of the internal plumbing of the ventilator, the patient's full mandatory needs are being supplied by the machine. Wether or not the patient is ineffectively breathing around the ventilator is irrelevant as long as the ventilator is providing all the patient's needed minute ventilation. d) Use Sengstaken-Blakemore or Linton tube for esophageal or gastric bleeding. e) Pitressin infusion via IMA, SMa, gastric artery catheters for control of gastrointestinal bleeding, or other intra-arterial infusion. This does nor includ standard 3 ml/h heparin flush to maintain catheter patency. g) Active pacing even if a chronic pacemaker. h) Include first 2 runs of an acute dialysis. Include chronic dialysis in patient whose medical situation now renders dialysis instable. j) Continuous or intermittent cooling to achieve body temperature less than 33°C. k) Use of a blood pump or manual pumping of blood in the patient who requires rapid blood replacement. p) May even be the initial emergency operative procedure - precludes diagnostics tests, i.e. angiography, CT scan.
3 Point Interventions : d) The patient is supplying some of his own venlatory needs. g) Not a daily point score. Patient must have been intubated in the ICU (elective or emergency) within previous 24 h. i) Measurement of intake/output above and beyond the normal 24 h routine. Frequent adjustment of intake according to total output. x) Includes Rheomacrodex. bb) For example, Strykerframe, CircOlectric.
2 Point Interventions : g) Replacement of clear fluids over and above the ordered maintenance level.
1 Point Interventions : k) Must have a decubitus ulcer. Does not include preventive therapy.

General guidelines for use of TISS

1) Data should be collected at the same time each day, preferably in the morning and by the same observer.
2) A TISS item should be checked if it was performed at any time during the previous 24 h.
3) When the patient is discharged from the ICU, we recommend a discharge TISS that reflects the previous shift or 8 h period.
4) Total TISS points should decrease as the patient improves. Conversely, one can safely assume that if TISS points increase, more interventions or more intensive care is being delivered to the patient indicating deterioration of the patient's condition. Therefore, if the TISS points are rising while the patient is, in fact, improving or vice versa, check for errors because interventions may have been added inappropriately. A simple question to the patient's nurse concerning the patient's current status is helpful.
5) Many interventions are interrelated and can be automatically eliminated from consideration. For example, if the patient was extubated for previous 24 h, any intervention related to an intubated patient such as controlled ventilation will not apply.
6) When several related intervention are applied within the same 24 h, only award 1 set of points for the maximum intervention. For example, if a patient was on controlled ventilation (4 points), then paced on IMV (3 points), to CPAP (3 points), to T-piece (2 points), and then extubated all within the same 24 h period, assign only 4 points (for controlled ventilation), the maximum intervention offered.
7) Though not essential, we recommend that TISS data collectors have a critical care nursing background. they can easily identify the interventions and make the appropriate associations within and between categories. Collection time is minimized and results are reproducible.

Reference

Keene AR and al. Therapeutic Intervention Scoring System : Update 1983. Crit Care Med. 1983:11,1-3.