Moreno, R

Rhodes, A

Singer, M

Vincent, JL

Critical Care

English

Repositório do Centro Hospitalar de Lisboa Central, EPE

Moreno et al. Critical Care          (2023) 27:182  https://doi.org/10.1186/s13054-023-04468-9CORRESPONDENCE Open Access© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Critical CareReal-world inter-observer variability of the sequential organ failure assessment (SOFA) score in intensive care medicine: the time has come for an update: authors’ replyRui Moreno1,2*, Andrew Rhodes3, Mervyn Singer4, Jean‑Louis Vincent5 and On behalf of the authors. Dear Editor,Thank you for the opportunity to reply to the letter from Pérez-Torres et  al. regarding our manuscript [1]. Pérez-Torres supports our main contention that it is time to update the SOFA score to ensure it fulfils current require-ments following the many changes in clinical practice over the last three decades.The example provided is self-explanatory: in 1996, the clinical use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) was virtually non-existent. Consequently, it was not considered within the respira-tory dysfunction score. If the original rules described in the 1996 manuscript are applied, receiving VV-ECMO would score 3 points. If the rules are modified to incorporate VV-ECMO as a marker of greatest dys-function, then the score would be 4. The goalposts have shifted.A useful analogy is to compare a mathematical model to a molecule used for therapy. A change, even minor, in a single atom may result in no effect yet the molecule is different. Only after successful testing can it be imple-mented into clinical practice. This principle is not widely applied to mathematical models, even if the scientific reasoning is the same. We agree that it is time to change, and that the accumulation of these “small changes” was why we proposed the development and validation of a new “SOFA 2.0” score instead of a modification of the original system with the same name [3].Thank you for raising the attention to this important yet grossly underestimated problem.Author contributionsAll authors contributed equally to the writing of the answer to the letter to the editor.FundingNo funding received.Availability of data and materialsNot Applicable.DeclarationsCompeting InterestsRM has no competing interest to declare relevant to this article. AR has no competing interest to declare relevant to this article. MS has no competing This reply refers to the comment available online at https:// doi. org/ 10. 1186/ s13054‑ 023‑ 04449‑y. This comment refers to the article available online at https:// doi. org/ 10. 1186/ s13054‑ 022‑ 04290‑9.*Correspondence:Rui Morenor.moreno@mail.telepac.pt1 Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal2 Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal3 Adult Critical Care, St. George’s University Hospitals NHS Foundation Trust, St. George’s University of London, London, UK4 Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK5 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, BelgiumPage 2 of 2Moreno et al. Critical Care          (2023) 27:182 interest to declare relevant to this article. JLV is Editor‑in‑Chief of Critical Care—he has no other competing interest to declare relevant to this article.Ethical ApprovalNot applicable.Received: 21 April 2023   Accepted: 29 April 2023References 1. Moreno R, Rhodes A, Piquilloud L, Hernandez G, Takala J, Gershengorn HB, Tavares M, Coopersmith CM, Myatra SN, Singer M, Rezende E, Prescott HC, Soares M, Timsit J‑F, de Lange DW, Jung C, De Waele JJ, Martin GS, Summers C, Azoulay E, et al. The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update? Crit Care. 2023;27:15. 2. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis‑related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis‑Related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10. 3. Rowan K. The reliability of case mix measurements in intensive care. Curr Opin Crit Care. 1996;2:209–13.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in pub‑lished maps and institutional affiliations.

Real-World Inter-Observer Variability of the Sequential Organ Failure Assessment (SOFA) Score in Intensive Care Medicine: the Time Has come for an Update: Authors’ Reply

Real-World Inter-Observer Variability of the Sequential Organ Failure Assessment (SOFA) Score in Intensive Care Medicine: the Time Has come for an Update: Authors’ Reply

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