A new prediction score for critically ill patients—do we need an Apgar score for acute respiratory distress syndrome?

Back in 1952 the anesthesiologist Virginia Apgar invented a score to quickly summarize the health of neonates (1). The scale of the score was determined by evaluating a neonate on five simple criteria on a scale from zero to two, then summing up the five values thus obtained, at 1 and 5 minutes after birth. Some 10 years after initial publication, a backronym for the score was coined in the United States as a mnemonic learning aid: appearance (skin color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration, or “Apgar score”. Of note, the purpose of the “Apgar score” was to determine quickly whether a newborn needed immediate medical care—it was not designed to predict long-term outcome; nevertheless, a score that remains <3 at later time points may indicate longer term neurological damage.