Overview :

The Sickness Scale is based closely upon the Apache II score and is intended  to assess critically ill patients transported between hospitals.

Assessments performed:

(1) before and after resuscitation

(2) on return to base

(3) after 24 hours of intensive care

Differences from Apache II:

(1) Measurements are in SIU.

(2) The FIO2 to PaO2 ratio is calculated rather than A-aDO2 or PaO2 as a measure of oxygenation (FIO2 as percent inspired oxygen, PaO2 in kPa).

(3) The hemoglobin is used rather than hematocrit, and the breakpoints for each score are slightly different when units are adjusted for, where hemoglobin = ((hematocrit) / 2.94).

(4) The breakpoints for creatinine differ when units are adjusted for. (1 mg/dL = 88.4 µmol/L).

(5) A chronic disease must be sufficiently severe to prevent independent self-care.

(6) In Apache II, the more extreme (maximum or minimum) value for temperature, mean arterial pressure, heart rate and respiratory rate are used, as opposed to single values in the Sickness Score.

Interpretation:

• The higher the score the worse the prognosis.

• Scores > 19 are usually associated with subsequent death.

• While the scores for non-survivors may fall after resuscitation, the subsequent outcome is unaffected.

Bion JF, Edlin SA, et al. Validation of a prognostic score in critically ill patients undergoing transport. Br Med J. 1985; 291: 432-434.

Bion JF, Logan BK, et al. Sedation in intensive care: morphine and renal function. Intensive Care Med. 1986; 12: 359-365.

Bion JF, Aitchison TC, et al. Sickness scoring and response to treatment as predictors of outcome from critical illness. Intensive Care Med. 1988; 14: 167-172.