Assessment of Prediction of Mortality by Using the APACHE II Scoring System in Intensive-Care Units

Marsh, H. Michael; I, Krishan; Naessens, James M.; Strickland, Robert A.; Gracey, Douglas R.; Campion, Mary E.; Nobrega, Fred T.; Southorn, Peter A.; McMichan, John C.; Kelly, Mary Pat

doi:10.1016/s0025-6196(12)62188-0

Cited by 50 publications

(14 citation statements)

References 12 publications

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“…This uses the worst value recorded in the first 24 h in the ICU for 12 physiological variables (weighted from 0 to 4 points), age, surgical status (emergency surgery or elective surgery/non-surgical) and previous health status and requires the selection of a primary reason for ICU admission for a logistic regression model that transforms scores into probabilities of mortality. This system soon became the scoring system used most word wide and has been used in administration, planning, quality assurance, comparison of ICUs [7][8][9][10][11][12][13][14][15][16][17] and even to assess comparability of groups in clinical trials [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

Moreno¹,

Morais²

1997

Intensive Care Medicine

149

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Section: Introductionmentioning

confidence: 99%

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

Moreno¹,

Morais²

1997

Intensive Care Medicine

149

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“…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.…”

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confidence: 99%

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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“…Mortality is a rather insensitive indicator of quality, as patients near death may not survive despite exemplary care. Prior research has also demonstrated that the link between process quality and mortality is not particularly strong (23,24). This outreach educational program is an innovative approach through which the quality of low-volume, highly specialized patient care service can be improved in the rural ICU setting.…”

Section: Discussionmentioning

confidence: 96%

Outreach Education to Improve Quality of Rural ICU Care

Hendryx

et al. 1998

Am J Respir Crit Care Med

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This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational program. After review of the medical records of eligible patients, a multidisciplinary team of intensive care unit specialists from an academic medical center delivered an educational program with content specific to the findings and capacity of the hospital. The outcome measures included patient care processes, patient morbidity and mortality outcomes, and resource use. Results indicated that the outreach program significantly improved many patient care processes (lab work, nursing, dietary management, ventilator management, ventilator weaning). The program marginally reduced hospital ventilator days. Both total length of stay and ICU length of stay fell markedly in the intervention group (by an average of 3.2 and 2.1 d, respectively), while the control group fell only 0.6 and 0.3 d, respectively. However, these effects did not reach statistical significance. Unfortunately, the program had no detectable effects on the clinical outcomes of mortality or nosocomial events. We conclude that an outreach program of this type can effectively improve processes of care in rural ICUs. However, improving processes of care may not always translate into improvement of specific outcomes.

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Assessment of Prediction of Mortality by Using the APACHE II Scoring System in Intensive-Care Units

Cited by 50 publications

References 12 publications

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

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

Outreach Education to Improve Quality of Rural ICU Care

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