Scoring Systems

Question 1

AAA outcome scoring

Answer 1

Hardman index (mortality 80% if >/=2)
- Age >76
- creat >190
- Hb <90
- ischaemia on ECG
- Hx of LOC pre admission

Glasgow aneurysm score (84 => 65% mortality)
- age in years
- shock +17
- myocardial disease +7
- cerebrovascular disease +10
- renal disease (creat >150 or urea >20) +14

Question 2

Kings criteria for paracetamol toxicity

Answer 2

within 24hrs
- PT >100. / INR >6.5
- Creat >300
- Grade III/IV encephalopathy

24hrs post paracetamol ingestion
- pH <7.3 following fluid resuscitation
- Lactate >3

Question 3

Kings criteria

Answer 3

For emergency liver transplant. Pt >100 (INR >6.5)

OR

3 of:
- PT > 50 (INR >3.5
- non hepatitis a/ e aetiology
- Age less than 10 or greater than 40
- Bilirubin >300
- duration of jaundice >7 days pre encephalopathy

Question 4

Injury severity score

Answer 4

One mark for each body system, scored to maximum of 6 (unsurvivable)

• head and neck
• face
• thorax
• abdomen
• extremities and pelvic girdle
• external

Question 5

True love and witts criteria

Answer 5

Severity of UC and indication for Colectomy at day 3
- greater or equal to 6 bloody stools per day
- one or more of fever >37.8, HR >90, Hb <105, CRP >30

Question 6

Child Pugh

Answer 6

Ascites, bilirubin, albumin, encephalopathy and INR

12 month survival
- class A 100%
- class B 85%
- class C 45%

Question 7

MELD score (modified end-stage liver disease)

Answer 7

Predicts 3 month mortality in patients with liver cirrhosis

• creatinine
• bilirubin
• INR
• sodium

Question 8

Q SOFA

Answer 8

Altered mental state GCS <15
RR greater than 22
Systolic BP < 100

Score greater or equal to 2 is high risk and 3-14x increase in hospital mortality

Question 9

APACHE 2 score

Answer 9

Mortality prediction tool
Worst values in the initial 24hrs of admission

Patient factors
- age, chronic organ dysfunction

Clinical features
- temperature
- MAP, HR
- AKI
- GCS
- FiO2

Lab values
- Na, K
- creat
- pH
- WCC, Hct

Question 10

Murray score

Answer 10

• Consolidation on CXR (0-4 quadrant)
• P/F ratio (>300 to <100)
• PEEP ( <5 to >15)
• compliance (>80 to <20)

Question 11

Risk scores for UGIB

Answer 11

Glasgow/blatchford score
- pre endoscopy to determine urgency of intervention
- urea, Hb, SBP; melaena, syncope, liver disease, cardiac failure
- zero can be managed as OP

AIMS65
- predicts mortality
- Albumin <30, INR >1.5, altered mental status, SBP <90, age >65
Score of 5 => 25% in hospital mortality

Rockall score
- post endoscopy score for mortality
- age, HR, SBP, comorbidities, diagnosis, stigmata of haemorrhage

Question 12

Shock index

Answer 12

Heart rate / systolic BP

Risk stratification into unstable Vs stable if >1

Question 13

Classification of TBI

Answer 13

Glasgow coma scale

Mild >/= 13
Moderate 9-12
Severe </=8

Question 14

Rapid shallow breathing index

Answer 14

Likelihood of succeeding weaning

RR <35
Vt >5ml/kg

RSBI = RR/Vt (in litres)

<65 likely to be successful
>105 likely to fail

Question 15

Critical care pain observation tool

Answer 15

clinical observation
- facial expression
- body movements
- muscle tension
- compliance with the ventilator for intubated patients or vocalization for extubated patients.

Each component has a score of 0-2, and total score ranges from o to 8. A score of >2 has a high sensitivity and specificity for predicting significant pain in postoperative ICU patients exposed to a painful procedure. 4,5

Question 16

Duke criteria

Answer 16

For diagnosis of infective endocarditis
= 2 major or 1 major + 3 minor or 5 minor

Major
- positive blood culture typical organism from 2 separate samples
- evidence of endocarditis on CT or TTE

Minor
- predisposing risk factor
- fever >38
- embolic phenomenon (janeway lesions)
- immunological phenomenon (osler’s nodes, Roth spots)
- micro evidence not in keeping with major criteria

Question 17

SCAI criteria (2019)

Answer 17

Cardiogenic shock score for communication and mechanical support discussions

ABCDE
A - at risk
B - beginning
C - classical
- hypoperfusion & organ dysfunction
D - deteriorating despite treatment
E - extremis & periarrest

Question 18

Hunter serotonin toxicity criteria

Answer 18

History of serotonergic agent

+ one of:
- Spontaneous clonus
- inducible clonus + agitation/diaphoresis
- ocular clonus + agitation/diaphoresis
- tremor + hyperreflexia
- hyperthermia + temp >38 + ocular/inducible clonus

Question 19

Standardised mortality ratio

Answer 19

Observed Vs predicted outcomes (APACHE II)

Question 20

SOFA score

Answer 20

• Applicable to all patients admitted to ICU
• Mortality predictor using worst value in last 24hrs

Resp (FiO2, PaO2, mechanical ventilation)

Cardio (MAP in the context of ionopressors)

CNS (GCS - assumed GCS if sedated)

Metabolic (bilirubin, creatinine/UO)

Haem (plt count)