Ats score

Established, well validated, prognostic clinical-medical parameter for risk stratification of a patient with dyspnea. The ATS score is a symptom-based classification and divides dyspnea into five grades (0 to 4) depending on the symptoms and the degree of severity of various characteristics:

• Grade 0: No dyspnoea. No shortness of breath - except during significant physical exertion.
• Grade 1: Mild dyspnoea. Shortness of breath when walking rapidly or slightly increasing.
• Grade 2: Moderate dyspnoea. Shortness of breath when walking normally on the flat, pauses to catch your breath even at your own pace.
• Grade 3: Severe dyspnea. Pauses when walking after a few minutes or after about 100 metres at walking pace.
• Grade 4: Very severe dyspnea. Too short of breath to leave the house. Shortness of breath when talking and/or dressing.

The aim is to predict lethality or to predict risk (identification of patients with a low risk of lethality who can be safely treated on an outpatient basis or those who require more intensive monitoring and therapy in the clinic).

Modified ATS-Score for the assessment of intensive care treatment:

Major Criteria:

• Necessity of intubation and machine ventilation
• Need to administer vasopressors > 4 hours (septic shock)

Minor criteria:

• severe acute respiratory insufficiency (paO2 / FiO2 <250)
• multilobular infiltrates in the ro- thorax
• systolic blood pressure < 90 mmHg
• disturbed consciousness
• respiratory frequency > 30/min
• acute renal failure
• Leukopenia
• thrombocytopenia
• Hypothermia

If at least 1 major criterion or 2 minor criteria are positive, immediate intensive medical treatment is recommended. The sensitivity of the ATS score is 69%, the specificity 97%, the predictive value 94%.

With regard to the prediction of lethality, the CRB-65 Index has established itself as a simple score with good prediction of the risk of lethality. Alternatively, the CURB score can be used in conjunction with a laboratory parameter (U=Urea).

1. Kostianev SS et al (2001) A factor analysis of dyspnea indexes and lung function parameters in patients with chronic obstructive pulmonary disease. Folia Med (Plovdiv) 43:27-31.
2. Valencia M et al (2007) Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores. Chest 132:515-522.