J Trauma
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Comparative Study
Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS.
Risk stratification of patients in the intensive care unit (ICU) is an important tool because it permits comparison of patient populations for research and quality control. Unfortunately, currently available scoring systems were developed primarily in medical ICUs and have only mediocre performance in surgical ICUs. Moreover, they are very expensive to purchase and use. We conceived a simple risk-stratification tool for the surgical ICU that uses readily available International Classification of Diseases, Ninth Revision, codes to predict outcome. Called ICISS (International Classification of Disease Illness Severity Score), our score is the product of the survival risk ratios (obtained from an independent data set) for all International Classification of Diseases, Ninth Revision, diagnosis codes. ⋯ Because ICISS is both more accurate and much less expensive to calculate than APACHE II score, ICISS should replace APACHE II score as the standard risk stratification tool in surgical ICUs.
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Cellular Injury Score (CIS) is an index of cellular injury, being calculated from three parameters of intracellular metabolism: arterial ketone body ratio, osmolality gap, and blood lactate. ⋯ CIS could be a useful index for mortality risk prediction and is potentially applicable as a severity scoring system for individual patients with MOF.
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To evaluate functional recovery after suture of the sciatic nerve after missile injury. ⋯ We advocate exploration of the sciatic nerve at any level within 3 months if no spontaneous recovery occurs after a missile injury. We do not advocate exploration of the sciatic nerve at the buttock level if only peroneal function is lost except in children.