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[Validation of a Therapeutic Intervention Scoring System (TISS-28) in critically ill children]
Ana Vivanco-Allende1, Corsino Rey2, Andrés Concha1
1Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
Insights
The Simplified Therapeutic Intervention Scoring System (TISS 28) is a reliable and easy-to-use scale for assessing patient severity in pediatric intensive care units. Validation confirms TISS 28 can effectively replace the TISS 76 scale, improving clinical practice.
Area of Science:
- Pediatric Intensive Care
- Clinical Assessment Tools
- Medical Informatics
Background:
- Numerous patient severity scales exist for ICUs, but many are time-consuming.
- The Therapeutic Intervention Scoring System (TISS 76) is validated but laborious.
- The Simplified Therapeutic Intervention Scoring System (TISS 28) offers a simpler alternative but requires validation in pediatric settings.
Purpose of the Study:
- To validate the Simplified Therapeutic Intervention Scoring System (TISS 28) in a pediatric intensive care unit (PICU).
- To assess the reliability and applicability of TISS 28 as a rapid severity scoring scale.
Main Methods:
- A prospective, non-interventional observational study was conducted in a university hospital's PICU.
- Data from 935 consecutive patients over 3 years included TISS 76 and TISS 28 scores for the first 4 days of admission.
- Patient outcomes were recorded and correlated with TISS scores.
Main Results:
- Mean TISS 76 and TISS 28 scores on day 1 were 18.27 and 18.02, respectively.
- Significantly higher scores were observed in patients with sequelae or mortality (P<.01).
- A strong correlation (Pearson's r > 0.9) was found between TISS 76 and TISS 28, with TISS 28 explaining 82.4% of TISS 76 variability.
Conclusions:
- The TISS 28 scale is validated for use in this PICU, demonstrating reliability and ease of application.
- TISS 28 can effectively replace TISS 76 without compromising the quality of patient severity assessment.
- The simplified nature of TISS 28 enhances its practical utility in clinical settings.
Introduction:
There are numerous scales in intensive care units that are used to quantify the severity of patients. Most of them are very useful, although sometimes laborious to complete, thus limiting their use in usual practice. One of these scales, the Therapeutic Intervention Scoring System (TISS 76), has been validated in adult and paediatric units. Its simplified and updated version, the Simplified Therapeutic Intervention Scoring System (TISS 28), has not yet been validated in paediatric units. The aim of this study is to validate TISS 28, in order to have a simple and rapid scale.
Material And Method:
A prospective non-interventional observational study was conducted in a Paediatric Intensive Care Unit (PICU) of a university hospital. Data were collected from 935 consecutive patients admitted to the PICU over a 3-year period. These included the values of TISS 76 and TISS 28 during the first 4days of admission and the subsequent outcome of the patients.
Results:
The mean values of TISS 76 and TISS 28 for the first day of admission were 18.27 and 18.02, respectively. Values were higher in patients who had sequelae or died (17.58 versus 27.23 and 37.44, respectively for TISS 76 (P<.01); and 17.51 versus 23.80 and 33.44, respectively for TISS 28 (P<.01). A very good correlation was found between TISS 76 and TISS 28, with Pearson correlation and intraclass correlation coefficients> 0.9 (except for the 2nd day). The correlation equation for the overall 4 days was: TISS76=- 1.74+1.05×TISS28. TISS 28 was able to explain 82.4% of variability of TISS 76. The area under the curve with a confidence interval (CI) of 95% for the first day was 0.80 (0.73-0.87) for TISS 76, and 0.76 (0.67-0.84) for TISS 28.
Conclusions:
On observing the results obtained, TISS 28 can replace TISS 26 in our PICU, without worsening the information provided. Being a reliable scale and easier to apply, its practical application could be useful.
