Retrospective evaluation of the simplified Therapeutic Intervention Scoring System (TISS-28) in a surgical intensive care unit.

OBJECTIVE

To compare the simplified Therapeutic Intervention Scoring System (TISS-28) with its original version, to provide reference values of daily TISS-28 assessment and to describe its association with severity of illness in surgical patients.

DESIGN

Retrospective evaluation of prospectively collected audit data; four documentation periods.

SETTING

Ten-bed intensive care unit (ICU) in a surgical university hospital.

PATIENTS

One thousand nine hundred eighty-six consecutive admissions (1,808 patients; 10,448 observation days) who stayed on ICU for at least 6 h. Patients were in hospital for abdominal, vascular or trauma surgery. The average age was 61.5 years, the mean APACHE II score on admission 10.3 points.

INTERVENTIONS

None.

MEASUREMENTS

Raw data for APACHE II score and TISS were recorded daily. TISS-28 was calculated retrospectively from the original TISS data.

RESULTS

Average TISS-28 values (28.7 points; SD = 9.7) do not differ substantially from the original TISS values (28.2 points, SD = 10.9) and overall correlation is high (r = 0.935). Of the patients, 57.3 % left the ICU after 1-2 days as survivors with a mean daily TISS-28 of 20.0 points. Variability between documentation periods was higher with the original TISS. On average, patients with increasing severity of disease require an increasing amount of care. Survivors have lower TISS-28 values than non-survivors (27.6 vs 34.9).

CONCLUSIONS

In a surgical ICU the simplified version of TISS with 28 items (TISS-28) sufficiently reflects the amount of intensive care provided and may provide useful additional information on severity of disease and prognosis. It should replace the original index, at least in these cases.