[Potentialities and limitations of the score system in intensive medicine]

In intensive-care medicine, score systems serve to quantify the severity of diseases and to characterise patient groups on the basis of objective criteria. The principle is to describe the severity by adding up points. Objectives are to assess the prognosis, to establish the amount of treatment required and assist in clinical decision making. The most important examples of general scores covering more than one disease are Acute Physiology And Chronic Health Evaluation (APACHE-II, APACHE-III), Simplified Acute Physiology Score (SAPS) and Mortality Prediction Model (MPM). General scores assess the deviation of physiological parameters from the normal assuming that the degree of deviation reflects the severity of the disease. The Therapeutic Intervention Scoring System (TISS) constitutes a particular form which evaluates exclusively the amount of therapy required. Disease-specific scores (trauma scores, sepsis scores) take into account the fact that the nature and stage of specific disease determine the outcome in a typical way. Scores are adequately validated and suitable for evaluation of clinical studies or cost-benefit analyses by characterisation of patient populations. The use of score systems for individual prognosis is at present controversial. Their clinical significance might increase in that scores help to make medical decisions by contributing to early identification of endangered patients by systematic establishment and evaluation of investigation results. Scores are likely to be used increasingly in intensive-care medicine.