Applicability of the APACHE II model to a lower middle income country

Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka

“…Over 50% of patients eligible for reperfusion therapy received treatment within 12 hours of admission, and nearly three-quarters (72.0%) of patients diagnosed with a STEMI underwent PCI. These numbers are higher than previously reported in Sri Lanka and may positively reflect the impact of recent investments in hospital services by the Ministry of Health, such as making stents available for free at PCI centres since 2018 4 5 20–22. Antiplatelet therapies and high-intensity statins essential to reducing mortality in the AMI population were administered in over 75% and nearly 90% of all eligible patients, respectively (domains 4 and 5).…”

“…Similarly, the timely availability of physiological and biochemical information for risk stratification is encouraging. The utilisation of such tools in front-line clinical care is reflective of an evidence-based approach to medicine and of a notable improvement in the availability of laboratory and point of care testing, the absence of which so often underlies the failure to apply risk stratification tools for acutely unwell patients in resource-limited settings 10 21…”

Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS‐ICU)

“…1,2 Work undertaken by our groups in resourcelimited settings has demonstrated challenges in the development and application of relatively simple prognostic models such as APACHE II. [3][4][5][6] Missing predictor variables, lack of post-ICU outcome measures, poor clinical uptake of scores due to perceived complexity and poor adherence to guidelines such as TRIPOD transcend healthcare settings. [3][4][5]7 As data missingness is widespread in resource-limited settings, we support the a priori decision to exclude variables with missingness > 25% and to utilise multiple imputation to address lesser proportions of missingness.…”

“…We also suggest cross-validation of simplified prognostic models developed in both High Income Countries 1,2 and LMICs. [4][5][6][7] This will also provide insights into generalisability of the models across diverse settings, with regard to differences in casemix, available healthcare facilities and variations in presentation.…”

Management of sepsis in resource poor countries: cutting your coat according to your cloth

“…12 The tool or scoring system used for diagnosis of sepsis should be validated in resource poor settings and should have simple and easily obtainable values or parameters at bedside. 9,13,14 Besides early detection, initial focused resuscitation, together with proper post-resuscitation monitoring and reassessment can improve outcome in patients with sepsis in resource limited settings. 12 Knowledge and understanding of sepsis if often sub-optimal in the first line health care workers from resource limited settings.…”