Serial measurement of Therapeutic Intervention Scoring System-28 (TISS-28) in a surgical intensive care unit ☆,☆☆ Norman Muehler MD, Janaina Oishi MD, Martin Specht MD, Florian Rissner Dipl.lng., Konrad Reinhart MD, Yasser Sakr MD, PhD ⁎ Department of Anesthesiology and Intensive Care, Friedrich-Schiller University Hospital, Jena 07743, Germany Keywords: Severity of illness; Mortality; Workload Abstract Purpose: The aim of the study was to assess the use of the Therapeutic Intervention Scoring System-28 (TISS-28) in surgical intensive care unit (ICU) patients and the relationship of the score to the type of surgery, severity of illness, and outcome in these patients. Materials and Methods: Prospectively collected data from all patients admitted to a postoperative ICU between March 1, 2004, and June 30, 2006, were analyzed retrospectively. Results: A total of 6903 patients were admitted during the study period (63.5% male; mean age, 62.3 years) constituting 29 140 observation days. The mean Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), and TISS-28 scores on the day of ICU admission were 36.9 ± 18.2, 5.8 ± 3.9, and 43.2 ± 10.8, respectively. The highest admission TISS-28 was observed in patients who underwent cardiothoracic surgery (47.7 ± 10.1), the lowest in neurosurgical patients (40 ± 9.6), and both declined during the 2 weeks after ICU admission; however, in trauma patients and those admitted after gastrointestinal surgery, TISS scores increased gradually after the first 2 to 5 days in the ICU. The TISS-28 score was moderately correlated to SAPS II (R 2 = 0.42; P b .001) and SOFA score (R 2 = 0.48; P b .001) throughout the ICU stay and was consistently higher in nonsurvivors than in survivors during the first 2 weeks in the ICU. Conclusions: There are marked variations in TISS-28 scores according to the type of surgery. Therapeutic Intervention Scoring System-28 correlates with the severity of illness and outcome in these patients. © 2010 Elsevier Inc. All rights reserved. 1. Introduction Over the last few decades, several scoring systems have been developed for use in critically ill patients not only to assist therapeutic decision making but also to guide resource allocation and quality of care [1]. The Therapeutic Intervention Scoring System (TISS) was developed by Cullen and colleagues [2] in 1974 from a list devised by a panel of experts and includes 76 therapeutic activities ☆ The author(s) declare that they have no competing interests. ☆☆ The study was supported by institutional funds only. ⁎ Corresponding author. Tel.: +49 3641 9323248; fax: +49 3641 9323102. E-mail address: yasser.sakr@med.uni-jena.de (Y. Sakr). 0883-9441/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2010.03.008 Journal of Critical Care (2010) 25, 620–627