PEDIATRICS Vol. 90 No. 4 October 1992, pp. 561-567
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Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-of-Illness Index

James E. Gray MD, SM1, Douglas K. Richardson MD, MBA1, Marie C. McCormick MD, ScD1, Kathryn Workman-Daniels PhD1, and Donald A. Goldmann MD2

1 Joint Program in Neonatology (Brigham and Women's Hospital, Children's Hospital, Beth Israel Hospital, and Harvard Medical School), Boston, MA.
2 Hospital Epidemiology Program (Children's Hospital and Harvard Medical School), Boston, MA.

Severity-of-illness scales have proven valuable able in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 ± 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

Key Words: neonatal intensive care • neonatal mortality • severity-of-illness index

Submitted on August 13, 1991
Accepted on February 18, 1992




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