Entwicklung der Software SCORATES zur semiautomatischen Erfassung intensivmedizinischer Scoresysteme

Nowadays intensive care medicine faces financial constraints, which lead to extended discussions about cost-benefit aspects. In this context the assessment of structural and process quality as well as the outcome measurement have become very important. Therefore scoresystems have been developed during the last century to assess lethality and morbidity of patients and also the workload of staff. They are composed of parameters and according to the different parameters’ value, different amounts of points are awarded. A mathematical function defines the final score and characterizes the patient´s status objectively. But until now there were two main handicaps. On the one hand there is the high expenditure of time that qualified staff spends on working with these systems. On the other hand significant discrepancies in the results of different observers are common. Thus SCORATES has been developed to calculate the three scoresystems SAPS II, SOFA and TISS 28 semiautomatically to compensate these problems. SCORATES consists of four complementary modules. The databasemanagement-module connects to the so-called “Stationsprogramm” which writes physicians’ letters and contains demographic information as well as results of the laboratory tests. SCORATES analyses these data and generates a task list of all patients who need to be scored. Then the status of these patients is checked, i.e. whether they have been recently admitted to the intensive care unit, discharged or have died. Unknown information is requested from the user in a kind of interview. By integrating the actual date and the patient´s length of stay SCORATES calculates the score relevant time slices for each patient. Loaded with these data the score-module PhysioAssist collects the necessary information regarding the parameters for this specific patient and period of time automatically. Afterwards the parameter values are converted into score-specific points and the final score is calculated. In this way SCORATES proceeds with the residual patients and time slices from the task list. After completing this the elapsed time is logged by the statistic module. The analysis module allows an interface to the software SPSS to evaluate the data. SCORATES was validated by comparison of its results with the examinations of an expert using the method of Bland and Altman. The logged elapsed time was compared with the protocols of the manual acquisition in 1997. Regarding the arithmetic mean, the standard deviation and the 95% confidence interval there was no significant difference between the two modes of acquisition. Accordingly the Bland and Altman plots showed no systematic shift. As a result you can state that the higher the level of automation, the lower the bias. SCORATES reduces the working time from 254 seconds ± 46 in 1997 to 115 seconds ± 36. In conclusion, SCORATES enables the user to score like an expert although the user changes weekly. Furthermore, it improves the data integrity through standardized processing of all patients. Due to an interface problem SCORATES does not register patients who stay less than 24 hours in the intensive care unit. Moreover, SOCRATES must be administered manually because of hand-over faults from the “Stationsprogramm”. In summary, SCORATES is suitable for daily use to assess the scoresystems SAPS II, SOFA and TISS 28 because of three innovations: it systematically introduces standardized processed data, a user supervising technique and also the integration of existing digital structures