Les indices de gravite en reanimation [a propos de 340 cas] etude retrospective et prospective

ABSTRACT

The objective evaluation of the medical activity of a polyvalent I.C.U. at present orients towards the utilization of a system of classification which rests on severity scores that are non specific. Five scores were selected for the study, either for physiological [A.P.S., S.A.P.S.] or for a therapeutic approach [T.I.S.S., T.IS.S. simplified]. The study includes 350 patients, which was conducted in a retrospective manner [one out of two patients] and prospective [successive admissions] by an independent observer. The statistic methodology, based on informational indexes and linear adjustment, was made easier by the adoption of the code and diagnostic catalogue of the "Societe de R‚animotion de Langue Francaise" [S.R.L.F.], notably by the level of the computerized exploitation of the data. The authors, while reaffirming, the predective value of the method used, they characterized the profile of their patients by numerical values and compared them to two other similar foreign studies. This evaluation also includes the determination of the specific severity caused by the morbid entities, the most representative of the series, and the relation of cost-effectiveness was determined by a curve having the parabolic shape which shows the limits of the intensive care. In addition the necessity for the planification of the care led the authors to propose a predictive model on the original classification of three groups of patients; - the model uses simple and reliable scores, a sequence of well defined measures, and a prognostic delay 48 hours. The purpose of this model is that it allows for a dynamic surveillance of the patients and the rational reevaluation of the care while the patients change from the one class to the other. At the conclusion of the study, the authors proposed the severity scores as indicators of the level of care, their evaluation on a large scale could leave to suggest the needs of intensive care at the national level