APACHE II-A Severity of Disease Classification System

Knaus, William A.; Draper, Elizabeth A.; Wagner, Douglas P.; Zimmerman, Jack E.

doi:10.1097/00003246-198608000-00028

Cited by 7,114 publications

(7,833 citation statements)

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“…However the mean APACHE II scores in these patients were still greater than the mean observed in an unselected group of ICU patients studied by Knaus et al 12 suggesting that patients in this category were not less sick overall.…”

Section: Discussioncontrasting

confidence: 57%

“…Patients in the no-support category required none of these three interventions during their ICU stay. Although this latter group of patients had a lower mean APACHE II score (25.4 vs 36) than those requiring 701 Table 4 Indications for mechanical ventilation and post-ventilation survival more intervention, this mean score is still greater than the mean observed by Knaus et al 12 in an unselected group of ICU admissions. Fifty percent of the patients requiring no supportive measures in ICU were admitted with impending respiratory failure but did not go on to require mechanical ventilation; the remainder included a number of patients admitted for multi-organ failure, GI bleeding or invasive monitoring not available on the BMT Unit.…”

Section: Relationship Of Survival To Level Of Supportive Carementioning

confidence: 50%

“…It is a widely utilized scoring system which can prognostically stratify patients at the time of ICU admission and was calculated in the standard way using the worst value of relevant physiological parameters observed during the first 24 h of ICU admission. The predicted death rate was computed from the APACHE II scores using the method outlined by Knaus et al 12 Respiratory failure was defined as hypoxemia (arterial pO 2 Ͻ50 mmHg and/or hypercapnia (arterial pCO 2 Ͼ50 mmHg). Patients with sepsis/hypotension had systemic evidence of infection associated with a systolic blood pressure Ͻ90 mmHg despite adequate fluid resuscitation.…”

Section: Methodsmentioning

confidence: 99%

“…11 Making such predictions is important in allocating potentially scarce resources but is also of potential clinical benefit to physicians in making treatment decisions and advising patients and their families about likely or expected outcomes. Previous retrospective studies of ICU admissions in patients with hematologic malignancies or who have undergone BMT have studied the value of utilizing the APACHE II scoring system [12][13][14] with conflicting results. 1,5 While advanced age and the need for mechanical ventilation are generally felt to be predictors of a poor outcome, further stratification of patients according to prognostic factors at the time of admission or early in their ICU stay remains limited and useful guidelines for physicians and family members about the likelihood of a given BMT patient surviving the ICU admission are difficult to find.…”

mentioning

confidence: 99%

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Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

Jackson

Tweeddale

Barnett

et al. 1998

Bone Marrow Transplant

131

115

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Summary:The role of ICU support in BMT patients is controversial. In an era of constrained resources, the use of prognostic factors predicting outcome may be helpful in identifying patients who are most likely (or unlikely) to benefit from this intervention. We attempted to define the survival of patients admitted to ICU following autologous or allogeneic BMT and to identify those factors important in determining patient outcome. A retrospective study of all adult BMT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome. Pre-treatment, pre-ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival. 116 patients were admitted to ICU on 135 separate occasions with the primary reasons for admission being respiratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predictive of survival. Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, the APACHE II score, the year of ICU admission and the serum bilirubin as significant predictors of post-discharge survival. On multivariate analysis the year of ICU admission, the need for hemodynamic support and the serum bilirubin remained significant. The APACHE II score significantly underestimated survival in the 46% of patients with scores less than 35, and could only be used to predict 100% mortality when it exceeded 45. Twenty-three percent of all BMT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge. Of the 27 patients surviving to leave hospital, 16 remain alive with a median follow-up of 4. was identified which could be used to predict futility but patients requiring both hemodynamic support and mechanical ventilation, and those with an APACHE II score greater than 45 have a very poor prognosis and are unlikely to benefit from lengthy ICU support.

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Section: Discussioncontrasting

confidence: 57%

Section: Relationship Of Survival To Level Of Supportive Carementioning

confidence: 50%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

Jackson

Tweeddale

Barnett

et al. 1998

Bone Marrow Transplant

131

115

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“…There was interest in using the Sequential Organ Failure Assessment (SOFA) score, which captures information on respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems [17] and can be used to assess daily changes in a patient's status within the ICU. This is an advantage over APACHE [18] or SAPS [19], which predict mortality based on the first 24 hours of observation. However, SOFA requires measurements that are only generally applicable in ICU, such as arterial blood gas analysis.…”

Section: Surrogate Endpointsmentioning

confidence: 99%

Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition

Harris

McNamara

Lye

et al. 2017

Clinical Microbiology and Infection

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No standardised endpoint definitions exist to aid the design of trials that compare antibiotic therapies for bloodstream infection (BSI). We reviewed endpoints used in contemporary BSI studies and defined consensus endpoints using a modified Delphi process. Prospective studies, randomised trials or registered protocols comparing antibiotic therapies for BSI, published from 2005 to 2016, were reviewed. Different primary and secondary endpoints were defined for pilot (small-scale studies designed to evaluate protocol design, feasibility and implementation) and definitive trials (larger-scale studies designed to test hypotheses and influence clinical practice), as well as for Staphylococcus aureus and Gram-negative BSI. For pilot studies of S.

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Early Switch From Intravenous to Oral Antibiotics and Early Hospital Discharge

Ramirez¹,

Vargas²,

Ritter³

et al. 1999

Arch Intern Med

201

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Objectives: To determine the proportion of patients who can be treated with early switch to oral antibiotics and early discharge, to evaluate clinical outcome and patient satisfaction for patients treated with early switch and early discharge, and to define the factors that interfere with early discharge for some of the patients who underwent early switch to oral antibiotic therapy.Design: Prospective study.Participants: Two hundred consecutive hospitalized patients with community-acquired pneumonia.Main Outcome Measures: Number of days needed to switch to oral therapy and length of hospital stay. Clinical outcome and satisfaction with care were evaluated for those patients treated with early switch and early discharge.Results: Early switch to oral antibiotics (within the first 3 days of hospitalization) was performed in 133 patients (67%). Clinical failure was documented in 1 patient. Early switch and early discharge was performed in 88 patients (44%). The mean length of hospital stay for this group was 3.4 days. The most common reason for prolonged hospitalization after the switch to oral antibiotics was the need for diagnostic workup. More than 95% of patients were satisfied with the care they had received. Conclusions:Using simple clinical and laboratory criteria, a significant proportion of hospitalized patients with community-acquired pneumonia (44%) can be treated with early switch and early discharge. This model did not affect patient outcome, decreased the length of hospitalization, and was associated with a high level of patient satisfaction.

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APACHE II-A Severity of Disease Classification System

Cited by 7,114 publications

References 0 publications

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition

Early Switch From Intravenous to Oral Antibiotics and Early Hospital Discharge

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