Ressources et utilitaires

Scoring systems for ICU and surgical patients:

TISS-28 (Therapeutic Intervention Scoring System-28)

Basic Activities	Points			Ventilatory Support	Points
Standard monitoring. Hourly vital signs, regular registration and calculation of fluid balance.	5	yesno		Mechanical ventilation. Any form of mechanical or assisted ventilation with or without PEEP; with or without muscle relaxants; spontaneous breathing with PEEP).	5	yes	no
Laboratory. Biochemical and microbiological investigations.	1	yesno		Supplementary ventilatory support. Breathing spontaneously through endotracheal tube without PEEP; supplementary oxygen by any method except if mechanical ventilation parameters apply.	2	yes
Single medication, any route (IV, PO, IM, etc.).	2	yes	no	Care of artificial airways. Endotracheal tube or tracheostoma.	1	yesno
Multiple intravenous medications (more than 1 drug, single shots, or continuously)	3	yes		Treatment for improving lung function. Thorax physiotherapy, incentive spirometry, inhalation therapy, intratracheal suctioning.	1	yesno
Routine dressing changes. Care and prevention of decubitus and daily dressing change.	1	yesno		Renal Support
Frequent dressing changes (at least one time per each nursing shift) and/or extensive wound care	1	yesno		Hemofiltration techniques. Dialytic techniques.	3	yesno
Care of drains. All (except gastric tube).	3	yesno		Quantitative urine output measurement.	2	yesno
Cardiovascular Support				Active diuresis (e.g. furosemid > 0.5 mg/kg/day for overload).	3	yesno
Single vasoactive medication. Any vasoactive drug.	3	yes	no	Neurologic Support
Multiple vasoactive medications. More than1 vasoactive drug, disregard type and dose.	4	yes		Measurement of intracranial pressure.	4	yesno
Intravenous replacement of large fluid losses. Fluid replacement > 3 liters per square meter per day, disregard type of fluid administered.	4	yesno		Metabolic Support
Peripheral arterial catheter.	5	yesno		Treatment of complicated metabolic acidosis/alkalosis.	4	yesno
Left atrium monitoring. Pulmonary artery flotation catheter with or without cardiac output measurement.	8	yesno		Intravenous hyperalimentation	3	yesno
Central venous line.	2	yesno		Enteral feeding. Through gastric tube or other GI route (e.g. jejunostomy).	2	yesno
Cardiopulmonary resuscitation after arrest in the past 24 hours (single precordial percussion not included)	3	yesno		TISS-28 = TISS-28 = SUM (points for activities performed)    Time of nurse's care = (One TISS-28 point equals 10.6 minutes of each 8 h nurse's shift) TISS-76 correlation =   (Correlation beetwen TISS-28 and TISS-76: r = 0.93, r2 = 0.86) (TISS-28) = 3.33 + 0.97* (TISS-76)
Specific Interventions
Single specific interventions in the ICU. Naso or orotracheal intubation, introduction of a pacemaker, cardioversion, endoscopies, emergency surgery in the past 24 hours, gastric lavage. Routine interventions without consequences to the clinical condition of the patient, such as radiographs, echography, EKG, dressings or introduction of venous or arterial catheters, are not included.	3	yes	no
Multiple specific interventions in the ICU. More than one, as described above.	5	yes
Specific interventions outside of ICU. Surgery or diagnostic procedures.	5	yesno

Criteria of exclusion are applied in four conditions :

• "Multiple intravenous medications" excludes "Single medication";
• "Mechanical ventilation" excludes " Supplementary ventilatory support";
• "Multiple vasoactive medications" excludes "Single vasoactive medication";
• "Multiple specific interventions in the ICU" excludes "Single specific interventions in the ICU "

References

• Miranda DR et al. Simplified Therapeutic Intervention Scoring System : the TISS-28 items. Results from a multicenter study. Crit Care Med. 1996;24:64-73.
• Moreno R, Morais P. Validation of the simplified therapeutic intervention scoring system on an independent database. Intensive Care Med. 1997;23:640-644.