In Reply.—I appreciate the references provided by Koss.
In the system described in my article, scores of 3, 4, and 5 in the cardiovascular system were differentiated by the dosages of vasopressors required and by the degree of hypotension, as outlined in the Table. Similarly, the Table distinguished each scoring level in the pulmonary and in the renal systems. Specifically, creatinine levels were precisely stated for each score. Perhaps Koss failed to see the Table.
We did not present this scale to predict survival for a particular patient. Rather, we set out to devise a more accurate means of comparing one set of patients in intensive care with any other set of apparently similar, but often different, patients. Koss missed this point in the article, and therefore his comments about the statistical methods I used are tangential, at best.