Predicting Future Functional Status for Seriously Ill Hospitalized Adults: The SUPPORT Prognostic Model

Wu, Albert W.; Damiano, Anne M.; Lynn, Joanne; Alzola, Carlos; Teno, Joan M.; Landefeld, C. S.; Desbiens, Norman A.; Tsevat, Joel; Mayer‐Oakes, Allison; Harrell, Frank E.; Knaus, William A.

doi:10.7326/0003-4819-122-5-199503010-00004

Cited by 125 publications

(94 citation statements)

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“…Similarly, this observation may also suggest irreversibility of disease. Even though the application of individual mortality prediction remains limited and controversial with current physiologic scoring systems, [32][33][34][35] the Society of Critical Care Medicine Ethics Committee has proposed that patients with very poor prognosis or little chance of benefit should not be admitted to the ICU. 36 In making the decision to triage patients away from the ICU, this committee recommended the use of predictive instruments to help determine patient prognosis and likelihood of benefit.…”

Section: Discussionmentioning

confidence: 99%

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Nguyen

Rivers

Havstad

et al. 2000

Academic Emergency Medicine

151

102

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Abstract. Objectives:The changing landscape of health care in this country has seen an increase in the delivery of care to critically ill patients in the emergency department (ED). However, methodologies to assess care and outcomes similar to those used in the intensive care unit (ICU) are currently lacking in this setting. This study examined the impact of ED intervention on morbidity and mortality using the Acute Physiology and Chronic Health Evaluation (APACHE II), the Simplified Acute Physiology Score (SAPS II), and the Multiple Organ Dysfunction Score (MODS). Methods: This was a prospective, observational cohort study over a three-month period. Critically ill adult patients presenting to a large urban ED and requiring ICU admission were enrolled. APACHE II, SAPS II, and MODS scores and predicted mortality were obtained at ED admission, ED discharge, and 24, 48, and 72 hours in the ICU. In-hospital mortality was recorded. Results: Eighty-one patients aged 64 Ϯ 18 years were enrolled during the study period, with a 30.9% in-hospital mortality. The ED length of stay was 5.9 Ϯ 2.7 hours and the hospital length of stay was 12.2 Ϯ 16.6 days. Nine (11.1%) patients initially accepted for ICU admission were later admitted to the general ward after ED intervention. Septic shock was the predominant admitting diagnosis. At ED admission, there was a significantly higher APACHE II score in nonsurvivors (23.0 Ϯ 6.0) vs survivors (19.8 Ϯ 6.5, p = 0.04), while there was no significant difference in SAPS II or MODS scores. The APACHE II, SAPS II, and MODS scores were significantly lower in survivors than nonsurvivors throughout the hospital stay (p Յ 0.001). The hourly rates of change (decreases) in APACHE II, SAPS II, and MODS scores were significantly greater during the ED stay (Ϫ0.55 Ϯ 0.64, Ϫ1.02 Ϯ 1.10, and Ϫ0.16 Ϯ 0.43, respectively) than subsequent periods of hospitalization in survivors (p < 0.05). There was a significant decrease in APACHE II and SAPS II predicted mortality during the ED stay (Ϫ8.0 Ϯ 14.0% and Ϫ6.0 Ϯ 14.0%, respectively, p < 0.001) and equally at 24 hours in the ICU (Ϫ7.0 Ϯ 13.0% and Ϫ4.0 Ϯ 16.0%, respectively, p Յ 0.02). The APACHE II and SAPS II predicted mortality approached actual in-hospital mortality at approximately 12 hours and 36 hours after ED admission (in the ICU), respectively. Conclusions: The care provided during the ED stay for critically ill patients significantly impacts the progression of organ failure and mortality. Although this period is brief compared with the total length of hospitalization, physiologic determinants of outcome may be established before ICU admission. This study emphasizes the importance of ED intervention. It also suggests that unique physiologic assessment methodologies should be developed to examine the quality of patient care, improve the accuracy of prognostic decisions, and objectively measure the impact of clinical interventions and pathways in the ED setting.

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Section: Discussionmentioning

confidence: 99%

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Nguyen

Rivers

Havstad

et al. 2000

Academic Emergency Medicine

151

102

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“…Severe functional limitation or severe morbidity is defined as being a score of 4 or less on the Index of ADL [14]. The mean follow-up of surviving patients ranged from 1 to 3 years with a mean of 2.2 years.…”

Section: The Functional Outcome Of Surviving Patientsmentioning

confidence: 99%

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Cho

Wang

1997

Intensive Care Medicine

101

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The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment. But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only for hospital and late mortality, but also for functional outcome.

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“…28,29 This study developed quantitative models for the prediction of outcomes of 9 severe disease states that in general performed somewhat better than directly elicited physician prognostication. [30][31][32] In any case, intensive efforts to provide physicians with timely information about patients' preferences and objectively computed prognoses were ineffective in changing physician behavior at the end of life. 33 This was despite large documented mismatches between physicians' actions and patients' stated preferences.…”

Section: Commentmentioning

confidence: 99%

Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists

Christakis¹,

Iwashyna²

1998

Arch Intern Med

403

303

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Predicting Future Functional Status for Seriously Ill Hospitalized Adults: The SUPPORT Prognostic Model

Abstract: Functional outcome varied substantially after hospitalization for a serious illness. A small amount of readily available clinical information can estimate the probability of severe functional limitations.

Cited by 125 publications

References 0 publications

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists

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