The “new” scores: what problems have been fixed, and what remain?

Abstract

Almost 10 years ago, the third generation of outcome prediction models, Acute Physiology and Chronic Health Evaluation (APACHE) III, Simplified Acute Physiology Score (SAPS) II, and Mortality Prediction Model (MPM) II were published. These systems proved better than their predecessors, and are considered the state of the art in this field. Their role was challenged recently by the reappearance of organ dysfunction/failure scores, which are viewed today as having am important role in patient description. Although we do not have a definitive answer about their role, data seem to indicate that they must be used to complement classical scores but not to replace them. In addition, debate continues about the advantages and disadvantages of disease-specific versus general scores as triage instruments, especially in the pre-intensive care unit setting. Although there have been 20 years of research in the fields of severity stratification and outcome prediction in intensive care, several development and application problems remain. It is time for researchers to combine their efforts to address them.