BackgroundAcute Physiology, Age and Chronic Health Evaluation (APACHE) II and III scores were developed in 1985 and 1991, respectively, and are used mainly for critically ill patients of all disease categories admitted to the intensive care unit (ICU). They differ in how chronic health status is assessed, in the number of physiologic variables included (12 vs. 17), and in the total score. These two scoring systems have not been compared in predicting hospital mortality in patients with sepsis.MethodsWe retrospectively identified all septic patients admitted to our 54-bed medical-surgical ICU between June 2009 and February 2014 using the APACHE outcomes database. We calculated correlation coefficients for APACHE II and APACHE III scores in predicting hospital mortality. Receiver-operating characteristic (ROC) curves were also used to assess the mortality predictions.ResultsWe identified a total of 2,054 septic patients. Average APACHE II score was 19 ± 7, and average APACHE III score was 68 ± 28. ICU mortality was 11.8% and hospital mortality was 18.3%. Both APACHE II (r = 0.41) and APACHE III scores (r = 0.44) had good correlations with hospital mortality. There was no statistically significant difference between the two correlations (P = 0.1). ROC area under the curve (AUC) was 0.80 (95% confidence interval (CI): 0.78 - 0.82) for APACHE II, and 0.83 (95% CI: 0.81 - 0.85) for APACHE III, suggesting that both scores have very good discriminative powers for predicting hospital mortality.ConclusionsThis study shows that both APACHE II and APACHE III scores in septic patients were very strong predictors of hospital mortality. APACHE II was as good as APACHE III in predicting hospital mortality in septic patients.

An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

BackgroundSepsis is a major contributor to mortality in patients admitted to a general intensive care unit (ICU). Early recognition and treatment of sepsis is key in improving outcomes. The epidemiology and outcome of sepsis in neurologic ICU (NeuroICU) has not been evaluated.MethodsWe retrospectively identified all patients admitted to our 16-bed NeuroICU between June 2009 and December 2013 using the acute physiologic and chronic health evaluation (APACHE) outcomes database. We excluded patients admitted with an infection, such as meningitis, encephalitis, brain or spinal abscess, or with any other infection. We compared NeuroICU patients who did to NeuroICU patients who did not develop sepsis after ICU admission. The diagnosis of sepsis was based on the SCCM/ACCP consensus conference definition.ResultsThere were a total of 2,025 patients, out of which 29 patients (1.4%) developed sepsis. Patients who developed sepsis had a trend towards older age (67 ± 13 vs. 61 ± 11 years, P = 0.07), a trend towards more male gender (69.0% vs. 51.5%, P = 0.07), significantly higher APACHE III scores (58 ± 17 vs. 43 ± 21, P = 0.0001), and significantly higher acute physiologic scores (APS) (43 ± 16 vs. 32 ± 18, P = 0.001) than patients who did not develop sepsis. Patients who developed sepsis had higher ICU mortality (41.4% vs. 5.1%, odds ratio (OR) = 13.1; 95% confidence interval (CI), 6.1 - 28.2, P < 0.0001), and higher hospital mortality (44.8% vs. 8.2%, OR = 9.0; 95% CI, 4.3 - 19.0, P < 0.0001).ConclusionsSepsis developed in 1.4% of patients admitted to a NeuroICU. Predictors of sepsis development were comorbidities and worsening acute physiologic variables. Patients who developed sepsis had significantly higher mortality. Vigilance to development of sepsis in NeuroICU is paramount, especially in this era when early recognition and intervention of sepsis significantly improves outcomes.