VA’s CADRE refines critical illness scoring system

The team at the Center for Access & Delivery Research and Evaluation (CADRE) continues to place novel and validated patient care at the forefront of its research. A group of Internal Medicine researchers within the Iowa City VA’s Center of Innovation have developed a new critical illness severity scoring system (CISSS), which helps physicians predict 30-day mortality through common variables. Their findings were published recently in the Journal of Critical Care.

Spyridon Fortis, MD, clinical associate professor in Pulmonary, Critical Care, and Occupational Medicine, is one of the physicians spearheading CISSS.

“This score will help us to assess the critical illness severity at the VA ICUs and can provide us a guide how to create severity illness scores in a real world,” Fortis said.

CISSS stemmed from mAPACHE, which was an APACHE III modification that CADRE created in 2018. Fortis says that CISSS is more accessible for physicians because it does not require proprietary software or dedicated research personnel like the APACHEs. Furthermore, CISSS proves to high accuracy rates similar to the known scoring systems like APACHE III and mAPACHE.

“We created a score with only simple variables available in every ICU admission that can be extracted from every electronic medical record using an automated process, so there’s no need for personnel,” Fortis said.

Taking samples from 2010–2015, the team drew data from 306 ICUs from 117 VAs across the country. CISSS considers easily accessible variables such as age, comorbidities, heart rate, mean arterial blood pressure, temperature, respiratory rate, hematocrit, white blood cell count, creatinine, sodium, glucose, albumin, bilirubin, bicarbonate, use of invasive mechanical ventilation, and surgical admission.

Other CADRE members who worked on this project include Amy O’Shea, PhD; Rajeshwari Nair, MBBS, MD, PhD; Michihiko Goto, MD, MSCI; Gregory Schmidt, MD; Peter Kaboli, MD, MS, FACP, MPH; Eli Perencevich, MD, MS; Heather Reisinger, PhD; Mary Vaughan-Sarrazin, PhD; and Brice Beck, MAE.

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