REVIEWS Risk Scoring in Perioperative and Surgical Intensive Care Patients: A Review Seetharaman Hariharan, MD* and Andrew Zbar, FRCS † *Department of Anesthesia and Intensive Care, The University of the West Indies, St. Augustine, Trinidad, West Indies; and † School of Clinical Medicine and Research, The University of the West Indies, Barbados, West Indies PURPOSE: Assessing the risk and predicting the outcome of surgery, trauma, and surgical intensive care is an important aspect of perioperative practice. There have been attempts to devise and validate many scoring systems to predict the prog- nosis of patients having a similar severity of illness. This article reviews some of the commonly used systems with respect to their development, strengths, and limitations. SOURCES: Published literature describing risk assessment scores and physiologic scoring systems for preoperative assess- ment, trauma, and surgical intensive care patients. PRINCIPAL FINDINGS: Risk scores used in preoperative evaluation assist the clinician in optimizing the patient before, during, and after surgery. Scoring systems applied in intensive care units are useful as guidelines rather than accurate predictors of prognosis for individual patient. Many models are used for audit purposes, and some are used as performance measures and quality indicators of a unit; however, both utilities are contro- versial because of poor adjustment of these systems to case- mixtures. CONCLUSIONS: Risk assessment scores may assist in the perioperative risk evaluation with respect to organ systems. Prognostication of critically ill patients belonging to a category of illness may be done using physiological scoring systems tak- ing into account the difference in the case-mixture of the par- ticular unit. (Curr Surg 63:226-236. © 2006 by the Association of Program Directors in Surgery.) KEY WORDS: surgical patients, risk evaluation, prognosis, intensive care, severity of illness, scoring systems INTRODUCTION Interhospital and interunit comparisons of surgical outcome are fraught with problems, including variation in case mix- ture, differences in surgical and anesthetic practices, as well as variability in operating categories and times. A scoring system that has been accurately validated for prediction of mortality and serious morbidity incorporating adjustment for patient risk may be able to provide such a comparison. 1 Simple validated scoring systems may serve many purposes, including safe patient triaging and treatment planning, de- cision making regarding intensity of monitoring and patient disposition, as well as auditing of unexpected mortality and comparison of the quality of care. Extended scoring tech- niques may potentially assist in the evaluation of score-di- rected therapeutic intervention and the more appropriate utilization of resources. An ideal scoring system should attempt to quantify a pa- tient’s risk of death or serious complication in critically ill pa- tients based on the severity of illness, which can be determined from readily obtainable objective data, early in the course of illness. It should be easy to use, should clearly define morbidity, and should be used for auditing purposes, 2 and it should be capable of being readily incorporated into preexisting audit pro- grams. 3 This review assesses the risk scoring methods available for preoperative assessment, physiological categorization of illness severity, sickness scoring for specific illnesses such as trauma and sepsis, and describes their development, clinical value, and current limitations. LITERATURE SEARCH STRATEGY A Medline literature search was performed with the key- words “anesthesia,” “risk assessment,” “intensive care unit scoring systems,” and “trauma scores.” All studies that intro- duced the various scoring systems and those that tested their utility and validated in different case-mixs were identified. Literature search included the commonly used scoring sys- tems described in this article with respect to their develop- ment, strengths, and limitations. Additionally, it also com- prised information regarding the application of scoring Correspondence: Inquiries to Seetharaman Hariharan, MD, Department of Anesthesia and Intensive Care, Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies; fax: 1 868 662 4030; e-mail: uwi.hariharan@gmail.com CURRENT SURGERY • © 2006 by the Association of Program Directors in Surgery 0149-7944/06/$30.00 Published by Elsevier Inc. doi:10.1016/j.cursur.2006.02.005 226