Decision-making is very crucial in problem-solving. As far as clinical decision-making is concerned, one has to resort to a very reliable objective system as it becomes a matter of life and death. For smooth clinical management, healthcare professionals resort to various scores and scales. A medical scoring system helps to accurately assess the risk, conditions, diagnosis and ultimately predict the outcome.
Characteristics of a medical scoring system
An ideal scoring system should have basic parameters that are efficient and can be trusted. The ideal scoring system would have the following characteristics:
- It should be based on easily/ routinely recordable variables
- It should be calibrated
- The system can be applied to all groups of patients
- It should be applicable across all geographic locations
- The system should be able to predict the status of the patient after hospital discharge
Medical scoring methods-
- Anatomical scoring- Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) fall under the anatomical scoring methods that are used for trauma patients. AIS, which was initially meant to document motor vehicle accidents, comprises a lexicon of six-digit coded injuries. A severity value of 1 (minor) to 6 (fatal) is given to the injuries under AIS. ISS is the summation of AIS scores from the squared values of the three most severely injured body areas. The scores ranges are from 0 to 75.
- Therapeutic scoring- This includes the Therapeutic Intervention Scoring System (TISS). This system assumes that the treatment procedures of very ill are patients are more complex than those who are less ill.
- Organ-specific scoring- This system assumes that the number of organs impacted will depend on the severity of the illness.
- Physiological scoring- This system takes into account the physiological variables depending on the degree of disorders present in them. For example, acute physiology and chronic health evaluation (APACHE) and simplified acute physiology score (SAPS) fall under the physiological scoring system.
- Simple scaling- Clinical judgment plays an important role here. For example, the Glasgow coma scale is used to evaluate patients admitted to an intensive care unit (ICU) following a drug overdose, for the mental status evaluation of the poisoned patients, the need for intubation in patients with antidepressant poisoning, and for predicting acute and delayed poisoning outcomes. Another example is the CRAMS Scale (Circulation, Respiration, Abdominal/ thoracic, Motor, and Speech). It measures five components: circulation, respiration, abdominal injury and motor and speech responses.
The scoring systems that are being followed currently are based on statistical models and correlations between recorded variables. They are not based on, nor do they account for, biological processes (including genomics) or healthcare organisational elements: factors that can influence outcomes and are overlooked by existing scoring systems. This is further compounded by our lack of complete biological understanding of common diseases presenting to the ICU (e.g. sepsis). These factors pose challenges for further refinement or developing new scoring systems in the future.
Future of scoring systems
Along with the advancements in the medical sector, the characteristics of patients have also changed with time. In order to keep up with the evolutions, medical scoring systems also need modifications. The implementation of electronic health records has created room for creating a better and accurate medical scoring system as it has become extremely easy to record, store, and analyse a variety of data. If the scoring systems are able to accurately predict the length of stay, the burdens of ICU care, and the resulting quality of life, it can prove to be a boon for the entire healthcare fraternity and the policymakers in the post-pandemic world.