The Index of Coexistent Disease (ICED) is a composite index of comorbidity for a patient. Each condition or limitation experienced by the patient has a score based on its severity and level of physical impairment.
Conditions or limitations:
(1) ischemic heart disease
(2) congestive heart failure
(3) arrhythmias
(4) other heart disease
(5) hypertension
(6) cerebrovascular disease
(7) peripheral vascular disease
(8) diabetes mellitus
(9) respiratory disease
(10) malignancy
(11) hepatobiliary disease
(12) arthritis
(13) gastrointestinal disease
(14) circulation
(15) respiration
(16) neurologic function
(17) mental function
(18) urinary elimination
(19) bowel elimination
(20) feeding
(21) ambulation
(22) transfer
(23) vision
(24) hearing
(25) speech
where:
• Some items (circulation, respiration) seem duplications of other items (peripheral vascular disease, respiratory disease).
|
Disease Severity |
Index of Disease Severity (IDS) |
|
none (condition absent) |
0 |
|
little or no morbidity |
1 |
|
symptomatic; condition active but controlled; requires ongoing treatment |
2 |
|
moderate to severe manifestations despite treatment |
3 |
from Table 1, page 321
|
Impairment |
Index of Physical Impairment (IPI) |
|
none, normal function |
0 |
|
mild to moderate impairment; may need assistance with activities of daily living |
1 |
|
severe impairment |
2 |
from Table 1, page 321
|
IDS |
IPI |
ICED Score |
|
0 |
NA |
0 (normal) |
|
1 or 2 |
0 |
1 (mild) |
|
1 or 2 |
1 |
2 (moderate) |
|
3 |
0 or 1 |
3 (severe) |
|
1, 2 or 3 |
2 |
3 (severe) |
from Figure 1, page 322
Although this is an impressive matrix, it can be compressed into the following:
|
Condition or Impairment |
ICED Score |
|
moderate or severe despite therapy |
3 |
|
severe impairment |
3 |
|
mild to moderate impairment |
2 |
|
mild or controlled condition without impairment |
1 |
Greenfield et al found that the ICED correlated with postoperative complications after total hip replacement as well as 1 year functional status.
|
ICED |
Rate of Postoperative Complications |
|
0 |
2.9% |
|
1 |
8.4% |
|
2 |
16.3% |
|
3 |
41.2% |
Table 2, page 147
I am not certain if it is feasible to combine multiple minor conditions into a higher score, but this may not be necessary if the overall degree of impairment is considered.
Purpose: To evaluate patients for comorbid conditions using the Index of Coexistent Disease (ICED).
Objective: disease progression, comorbid conditions, disability and performance, quality of life
ICD-10: ,
