Validation of a severity of illness score (APACHE II) in a surgical intensive care unit

Giangiuliani, G; Mancini, Antonio; Gui, Daniele

doi:10.1007/bf00273563

Cited by 70 publications

(28 citation statements)

References 13 publications

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“…In comparing the capability of the APACHE II system for predicting mortality through this method, we observed that in this patient population it was meaningfully lower than what was recorded in the study by Knaus et al 7 and some from other countries, 9,13,14,19 but similar to what was recorded in other studies, 6,8,17 including one from Brazil. 20 In the 2 x 2 decision matrix assessment, the most accurate classification percentage was obtained using criterion 0.4, which correctly classified 75.2% of the patients.…”

supporting

confidence: 72%

“…The ability of this gradational system to predict mortality rates for different patient groups has been assessed in several countries. 8,9,[12][13][14][17][18][19] The following items have been used for assessing the predictive capability of the APACHE II index: receiver operating characteristic curve, 2 x 2 decision matrix, and linear regression analysis (calibration curve).…”

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confidence: 99%

“…However, it was not as accurate as in other studies. 7,8,13,14,19 It had good discriminating power for distinguishing patients who survived from those who died; it also had good calibration, but it was generally not sensitive, specific and accurate enough to predict the patients' exact mortality. Likewise, it was not accurate enough to predict the patients' individual mortality.…”

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confidence: 99%

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Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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CONTEXT: The high-complexity features of intensive care unit services and the clinical situation of patients themselves render correct prognosis fundamentally important not only for patients, their families and physicians, but also for hospital administrators, fund-providers and controllers. Prognostic indices have been developed for estimating hospital mortality rates for hospitalized patients, based on demographic, physiological and clinical data. OBJECTIVE: The APACHE II system was applied within an intensive care unit to evaluate its ability to predict patient outcome; to compare illness severity with outcomes for clinical and surgical patients; and to compare the recorded result with the predicted death rate. DESIGN: Diagnostic test. SETTING: Clinical and surgical intensive care unit in a tertiary-care teaching hospital. PARTICIPANTS: The study involved 521 consecutive patients admitted to the intensive care unit from July 1998 to June 1999. MAIN MEASUREMENTS: APACHE II score, in-hospital mortality, receiver operating characteristic curve, decision matrices and linear regression analysis. RESULTS: The patients' mean age was 50 ± 19 years and the APACHE II score was 16.7 ± 7.3. There were 166 clinical patients (32%), 173 (33%) post-elective surgery patients (33%), and 182 post-emergency surgery patients (35%), thus producing statistically similar proportions. The APACHE II scores for clinical patients (18.5 ± 7.8) were similar to those for non-elective surgery patients (18.6 ± 6.5) and both were greater than for elective surgery patients (13.0 ± 6.3) (p < 0.05). The higher this score was, the higher the mortality rate was (p < 0.05). The predicted death rate was 25.6% and the recorded death rate was 35.5%. Through the use of receiver operating curve analysis, good discrimination was found (area under the curve = 0.80). From the 2 x 2 decision matrix, 72.2% of patients were correctly classified (sensitivity = 35.1%; specificity = 92.6%). Linear regression analysis was equivalent to r² = 0.92. CONCLUSIONS: APACHE II was useful for stratifying these patients. The illness severity and death rate among clinical patients were higher than those recorded for surgical patients. Despite the stratification ability of the APACHE II system, it lacked accuracy in predicting death rates. The recorded death rate was higher than the predicted rate.

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confidence: 72%

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confidence: 99%

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confidence: 99%

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Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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“…On the other hand, the calculation of this index requires at least two measurements of each physiological parameter and the second of these will be influenced by the intensive treatment. 30 Another obstacle is the subjectivity inherent in certain items on the worker's data sheets. The more researchers who apply this index, the less precise are the data.…”

Section: Discussionmentioning

confidence: 99%

Severity and prognosis in intensive care: prospective application of the Apache II Index

Costa¹,

Amaral

Munechika

et al. 1999

Sao Paulo Med. J.

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Context:The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. Objective: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. Design: Prospective study of patients' outcomes. Setting: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). Participants: 520 patients selected according to sex, age and nature of hospitalization. Diagnostic Test: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had nonsurgical treatment, emergency surgery and elective surgery. Main measurements: The APACHE II index. Results: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. Conclusions: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

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“…[15][16][17][18] Our objective was to determine, in a large number of patients, if echocardiographic data would add prognostication to existing clinical variables in MSICU patients. This clinical study attempts to associate specific cardiovascular pathology identified utilizing TTE with mortality in the MSICU.…”

Section: Objectifmentioning

confidence: 99%

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

Sawchuk

Wong

Kavanagh

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the hypothesis that transthoracic echocardiographic findings predict mortality in critically ill patients.M Me et th ho od ds s: : A retrospective analysis of concurrently collected data for consecutive patients from May 1996 to May 1998 who had transthoracic echocardiography on or within six months of admission to the medical surgical intensive care (MSICU). We examined the role of physiologic, clinical, and echocardiography variables in predicting the mortality of patients admitted to the MSICU. Three logistic regression models were developed: 1) clinical; 2) echocardiographic; and 3) combined clinical with echocardiographic. Univariate and multivariate analyses were performed and the relative strength of clinical and echocardiographic predictors was compared using odds ratio (OR) and receiver-operator-characteristic (ROC).

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Validation of a severity of illness score (APACHE II) in a surgical intensive care unit

Cited by 70 publications

References 13 publications

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Severity and prognosis in intensive care: prospective application of the Apache II Index

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

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