Validation of the new Intensive Care Nursing Scoring System (ICNSS)

Intensive Care Med. 2004 Feb;30(2):254-259. doi: 10.1007/s00134-003-2040-4. Epub 2004 Jan 9.


Objectives: To validate a new Intensive Care Nursing Scoring System (ICNSS).

Design: Retrospective data collection.

Setting: Adult 19-bed intensive care unit (ICU) in a tertiary care university hospital.

Patients: A total of 1,538 patient records of which 30 documents were included in the validation.

Measurements and results: Data included admission scores of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Simplified Acute Physiology Scores II (SAPS II), daily Therapeutic Intervention Scores (TISS) and ICNSS scores. Data were compared using Spearman's correlation, t-test and chi-square test. Receiver operating characteristics (ROC) curve analysis was used to assess the ability of ICNSS and TISS to predict mortality. Intra-class correlation, percentage agreement and kappa statistics were used to test the validity of given scores. Nursing workload assessment using ICNSS showed that medical and emergency-operated patients caused a greater nursing workload than electively operated patients (p<0.001). Six variables of the sub-scale that described vital function nursing accounted for 27.4% of the variation of SAPS II and for 37% of the variation of APACHE II. The ICNSS sub-scale of vital function nursing accounted for a ROC area of 0.91. In the validity of the given ICNSS scores, kappa was 0.81 and weighted kappa 0.82.

Conclusions: Nursing workload varied between the different admission types. ICNSS explained a similar percentage of the variation of the admission scores of APACHE II and SAPSS II as TISS and discriminated between non-survivors and survivors. ICNSS is a suitable nursing workload instrument to be used with the TISS score.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Critical Care*
  • Humans
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data*
  • Middle Aged
  • Nurses
  • Nursing Care*
  • Retrospective Studies