Utility of the Therapeutic Intervention Scoring System-28 to Predict Mortality in Intensive Care Units
Objectives: We compared the commonly used Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score with the quicker and easier Therapeutic Intervention Scoring System (TISS)-28) to examine mortality in intensive care units (ICUs).
Methods: Patients treated in the ICU at Bakirköy Dr. Sadi Konuk Research and Training Hospital between May 2012 and January 2017 were included in the present study. Patients who made a full recovery and were discharged were defined as group 1, whereas those who died were defined as group 2. TISS-28 scores recorded twice in the first 24 h and APACHE II and SOFA scores recorded at the end of 24 h were evaluated. The groups were compared based on demographic data; duration of nursing (h/day); and TISS-28, APACHE II, and SOFA scores.
Results: Of 2191 patients in this 5-year study, 1405 (64%; group 1) were discharged from the ICU and 786 (36%; group 2) died. There was no significant difference in age between the two groups. The median TISS-28 score was 17 in group 1 and 25 in group 2. The median APACHE II score was 18 in group 1 and 29 in group 2. The median SOFA score was 6 in group 1 and 8 in group 2. All three scores were significantly higher in group 2.
Conclusion: TISS-28 scores correlated with APACHE II and SOFA scores, predicting mortality.
1. Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974;2:57–60. [CrossRef]
2. Miranda DR, de Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System: the TISS-28 items-results from a multicenter study. Crit Care Med 1996;24:64–73. [CrossRef]
3. Padilha KG, Sousa RM, Kimura M, Miyadahira AM, da Cruz DA, Vattimo Mde F, et al. Nursing workload in intensive care units: a study using the Therapeutic Intervention Scoring System-28 (TISS-28). Intensive Crit Care Nurs 2007;23:162–9. [CrossRef]
4. Lee H, Shon YJ, Kim H, Paik H, Park HP. Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit. Korean J Anesthesiol 2014;67:115–22. [CrossRef]
5. Sedloň P, Kameník L, Škvařil J, Malý M, Táborský M, Zavoral M. Comparison of the accuracy and correctness of mortality estimates for Intensive Care Unit patients in internal clinics of the Czech Republic using APACHE II, APACHE IV, SAPS 3 and MPMoIII models. Med Glas (Zenica) 2016;13:82–9.
6. Brinkman S, Bakhshi-Raiez F, Abu-Hanna A, de Jonge E, Bosman RJ, Peelen L, et al. External validation of Acute Physiology and Chronic Health Evaluation IV in Dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II. J Crit Care 2011;26:105.e11–8. [CrossRef]
7. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–29. [CrossRef]
8. Teres D, Brown RB, Lemeshow S. Predicting mortality of intensive care unit patients. The importance of coma. Crit Care Med 1982;10:86–95. [CrossRef]
9. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10. [CrossRef]
10. Kisorio LC, Schmollgruber S, Bekker PJ. Validity and reliability of the simplified Therapeutic Intervention Scoring System in intensive care units of a public sector hospital in Johannes-burg. Southern African Journal of Critical Care 2009;25:36–43.
11. Moreno R, Morais P. Validation of the simplified therapeutic intervention scoring system on an independent database. Intensive Care Med 1997;23:640–4. [CrossRef]
12. Elias AC, Tiemi M, Cardoso LT, Grion CM. Application of the therapeutic intervention scoring system (TISS 28) at an intensive care unit to evaluate the severity of the patient. Rev Lat Am Enfermagem 2006;14:324–9. [CrossRef]
13. Raksakietisak M, Toomtong P, Vorakitpokatorn P, Sengleulur A, Sunjohndee M. TISS 28 or SOFA: good predicting factors for admission in a surgical intensive care unit longer than 24 hours. J Med Assoc Thai 2006;89:648–56.
14. Lefering R, Zart M, Neugebauer EA. Retrospective evaluation of the simplified Therapeutic Intervention Scoring System (TISS-28) in a surgical intensive care unit. Intensive Care Med 2000;26:1794–802. [CrossRef]
15. Ergan B, Tokur ME, Çoban S, Tursunoğlu S, Ergün R, Ergün D, et al. The Relationship between Nurse Workload and Mortality in Two Different ICUs. Yoğun Bakım Derg 2016;7:21–7. [CrossRef]
16. Muehler N, Oishi J, Specht M, Rissner F, Reinhart K, Sakr Y. Serial measurement of Therapeutic Intervention Scoring System-28 (TISS-28) in a surgical intensive care unit. J Crit Care 2010;25:620–7. [CrossRef]
17. Rocca B, Martin C, Viviand X, Bidet PF, Saint-Gilles HL, Chevalier A. Comparison of four severity scores in patients with head trauma. J Trauma 1989;29:299–305. [CrossRef]
18. Vasquez DN, Estenssoro E, Canales HS, Reina R, Saenz MG, Das Neves AV, et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest 2007;131:718–24.
19. Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, et al. Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med 2007;35:2538–46. [CrossRef]