The SOFA system was created in a consensus meeting of the European Society of Intensive Care Medicine in 1994 and further revised in 1996. The SOFA is a six-organ dysfunction/failure score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal), providing a daily score of 0 to 24 points. The objective in the development of the SOFA was to create a simple, reliable, and continuous score easily obtained in every institution.
The Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recently reviewed risk factors and developed objective major and minor criteria to identify patients who require direct admission to an Intensive Care Unit (ICU). The most up-to-date definitions use need for invasive mechanical ventilation or septic shock, requiring vasopressors, as absolute indicators for direct admission to an ICU. For patients who do not meet either of these two major criteria, minor criteria have been proposed that are based on CURB-65 and ATS criteria with new additions. For admission to an ICU or high level unit, patients must fulfill at least three of these minor criteria.
Clinical Criteria for Brain Death in Adults and Children
- Absence of motor responses
- Absence of pupillary responses to light and pupils at midposition with respect to dilatation (4–6 mm)
- Absence of corneal reflexes
- Absence of caloric responses
- Absence of gag reflex
- Absence of coughing in response to tracheal suctioning
- Absence of sucking and rooting reflexes
- Absence of respiratory drive at a PaCO2 that is 60 mm Hg or 20 mm Hg above normal base-line values*
- Interval between two evaluations, according to patient’s age Continue reading
A DNR order may be written any time that two of the following clinical criteria are present and the prognosis has become clear for and shared whenever possible between physician(s), patient, and family (or appropriate surrogate).
Criteria for Chronic Respiratory Failure due to Cardiopulmonary Disorders in Infants and Children
- Decreased inspiratory breath sounds
- Increased retractions, use of accessory muscles
- Cyanosis breathing room air
- Decreased level of normal activity/function
- Poor weight gain (mass) (IMPORTANT)
CURB and CRB-65 scores can be used in the hospital and out-patients setting to assess pneumonia severity and the risk of death.
Ranson Criteria to Predict Severity of Acute Pancreatitis
1. When three or more of the following are present on admission, a severe course complicated by pancreatic necrosis can be predicted with a sensitivity of 60-80%:
Multiple systems organ failure is said present when more than one of the system dysfunctions detected by test values exceeding the threshold values.
The Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. For adults the scores are as follows:
4 = eyelids open or opened, tracking, or blinking to command
3 = eyelids open but not tracking
2 = eyelids closed but open to loud voice
1 = eyelids closed but open to pain
0 = eyelids remain closed with pain