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Anästhesiol Intensivmed Notfallmed Schmerzther 2002; 37(9): 520-527
DOI: 10.1055/s-2002-33769
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Risikoindizes, Scoring-Systeme und prognostische Modelle in der Anästhesie und Intensivmedizin. Teil I: Anästhesie

Risk Predictors, Scoring Systems and Prognostic Models in Anesthesia and
Intensive Care. Part I: AnesthesiaA.  Junger, J.  Engel, L.  Quinzio, A.  Banzhaf, A.  Jost, G.  Hempelmann
  • 1Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Giessen
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Publication History

Publication Date:
05 September 2002 (online)

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Zusammenfassung

Um objektive und reproduzierbare Aussagen hinsichtlich der Prognose einer Erkrankung, des Eintretens einer Komplikation und der Wahrscheinlichkeit des Überlebens machen zu können werden in der Medizin Risikoprädiktoren und Scoring-Systeme eingesetzt. Sie dienen weiterhin als standardisierte Verfahren zur Klassifizierung des Krankheitsschweregrades, zur Verlaufsbeobachtung bei diagnostischen und therapeutischen Maßnahmen und zur Stratifizierung von Patientenkollektiven bei wissenschaftlichen Untersuchungen. Für das Qualitätsmanagement und Kosten-Nutzen-Analysen spielen diese Parameter im Rahmen der Risikoadjustierung und Aufwandsbeschreibung eine wichtige Rolle. In dieser Übersicht werden für die Anästhesie (Teil I) und Intensivmedizin (Teil II) die Möglichkeiten, aber auch die Grenzen der wichtigsten Risikoindizes und Scoring-Systeme beschrieben. Als Instrumente zur Erfassung des perioperativen Risikos und der Komplikationen stehen dem Anästhesisten verschiedene Klassifizierungs- und Scoring-Systeme zur Verfügung. Vor allem in der Kardiochirurgie führte das steigende Interesse an risikoadjustierten Outcome-Studien zur Entwicklung und Validierung einer großen Zahl von unterschiedlichen prädiktiven Modellen für die postoperative Mortalität, Morbidität und Krankenhausverweildauer. Auch für ganz bestimmte Risikosituationen wie z.B. schwierige Laryngoskopie oder postoperative Übelkeit und Erbrechen (PONV) existieren spezifische Scoring-Systeme. Im Vergleich zur ASA-Klassifikation haben Risikochecklisten und Risikoindizes den Vorteil der größeren Exaktheit und der Möglichkeit einer statistischen Risikoprognose. Trotzdem haben sie bis heute keine annähernd vergleichbare Verbreitung gefunden. Die ASA-Klassifikation hat sich auf Grund ihrer Einfachheit und schnellen Durchschaubarkeit weltweit durchgesetzt und ist laut einer neueren Untersuchung den wesentlich komplexeren Risikoindizes zumindest ebenbürtig.

Abstract

Risk predictors and scoring systems are commonly used in medicine to provide a reliable and objective estimation of disease prognoses, probability of adverse events and outcome. Furthermore, they were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance. The aim of this review article was to describe common risk indices and scoring systems in anesthesia (part I) and intensive care (part II), and to point out their possible benefits and limitations. Different scoring systems and classifications are available to stratify perioperative risk and adverse events in anesthesia. Especially in cardiac surgery, an increasing interest in risk-adjusted outcome studies led to the modeling and validation of different prognostic systems for postoperative morbidity, mortality and length of stay. Furthermore, there are scoring-systems for special events, such as difficult laryngoscopy or postoperative nausea and vomiting (PONV). Risk check lists and risk indices are superior to the ASA classification of physical status in providing more exact results and the possibility of statistic risk calculation. Nevertheless, they are not frequently used in clinical routine. Because of its simplicity and easy handling the ASA classification has worldwide popularity and recent studies demonstrated at least equal prognostic performance.

Schlüsselwörter:

Anästhesie - Intensivmedizin - Krankenhausmortalität - Risikofaktoren - Gesundheitszustand - Risikoklassifizierung

Key words

Anesthesiology - Critical Care - Hospital Mortality - Risk Factors - Health Status Indicators - Risk Assessment

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Dr. med. Axel Junger

Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitätsklinikum Giessen

Rudolf-Buchheim-Str. 7

35392 Giessen

Email: Axel.Junger@chiru.med.uni-giessen.de

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