Risk scoring in perioperative and surgical intensive care patients: a review.
OBJECTIVE
Assessing the risk and predicting the outcome of surgery, trauma, and surgical intensive care is an important aspect of perioperative practice. There have been attempts to devise and validate many scoring systems to predict the prognosis of patients having a similar severity of illness. This article reviews some of the commonly used systems with respect to their development, strengths, and limitations.


METHODS
Published literature describing risk assessment scores and physiologic scoring systems for preoperative assessment, trauma, and surgical intensive care patients.


RESULTS
Risk scores used in preoperative evaluation assist the clinician in optimizing the patient before, during, and after surgery. Scoring systems applied in intensive care units are useful as guidelines rather than accurate predictors of prognosis for individual patient. Many models are used for audit purposes, and some are used as performance measures and quality indicators of a unit; however, both utilities are controversial because of poor adjustment of these systems to case-mixtures.


CONCLUSIONS
Risk assessment scores may assist in the perioperative risk evaluation with respect to organ systems. Prognostication of critically ill patients belonging to a category of illness may be done using physiological scoring systems taking into account the difference in the case-mix of the particular unit.
Hariharan
Seetharaman
S
Department of Anesthesia and Intensive Care, The University of the West Indies, St. Augustine, Trinidad, West Indies. uwi.hariharan@gmail.com
Zbar
Andrew
A
D018806:APACHE; D016638:Critical Illness / Q000453:epidemiology*; D006305:Health Status Indicators; D006331:Heart Diseases / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology; D008171:Lung Diseases / Q000453:epidemiology / Q000503:physiopathology; D019990:Perioperative Care; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index