Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Comparison of APACHE II and III Scoring Systems for Mortality Prediction in Critical Surgical Illness

Comparison of APACHE II and III Scoring Systems for Mortality Prediction in Critical Surgical... Abstract Objective: To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness. Design: Prospective cohort study. Setting: Surgical intensive care unit of an urban, tertiary-care university hospital. Participants: Eight hundred forty-four consecutive patients in the surgical intensive care unit. Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups. Main Outcome Measures: Survival to hospital discharge, and survival compared with published normative APACHE II and III databases. Results: Mean age was 65.1 ±0.5 years. Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital. The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P<.0001) (range of correlation coefficients,.72 to.86) overall and in all subgroups. Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P<.01) higher overall and in all subgroups. Conclusions: In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.(Arch Surg. 1995;130:77-82) References 1. Frey CF, Suzuki M, Isaji S, et al. Assessment of severity of critical illness . In: Barie PS, Shires GT, ed. Surgical Intensive Care . Boston, Mass: Little Brown & Co; 1993:3-46. 2. Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE acute physiology and chronic health evaluation: a physiologically based classification system . Crit Care Med . 1981;9:951-956. 3. Knaus WA, Draper EA, Wagner DA, et al. An evaluation of outcomes from intensive care in major medical centers . Ann Intern Med . 1986;104:410-415.Crossref 4. Knaus WA, Draper EA, Wagner DP, et al. APACHE-II: a severity of disease classification system . Crit Care Med . 1985;13:818-824.Crossref 5. Bohnen JM, Mustard RA, Oxholm SE, et al. APACHE II score and abdominal sepsis . Arch Surg . 1988;123:225-229.Crossref 6. Headley J, Thierault R, Smith TL, Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit . Cancer . 1992;70:497-503.Crossref 7. Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients . Arch Surg . 1990;125: 519-524.Crossref 8. McAnena OJ, Moore FA, Moore EE, et al. Invalidation of the APACHE II scoring system for patients with acute trauma . J Trauma . 1992;33:504-506.Crossref 9. Sleigh JW, Brook RJ, Miller M. Time-dependent error in the APACHE II scoring system . Anaesth Intensive Care . 1992;20:63-65. 10. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults . Chest . 1991;100:1619-1636.Crossref 11. Knaus WA, Wagner DP, Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics . Science . 1991;254:389-394.Crossref 12. Holt AW, Bury LK, Bersten AD, et al. Prospective evaluation of residents and nurses as severity score data collectors . Crit Care Med . 1992;20:1688-1691.Crossref 13. Christou NV, Barie PS, Dellinger EP, et al. Surgical Infection Society intraabdominal infection study: prospective evaluation of management techniques and outcome . Arch Surg . 1993;128:193-198.Crossref 14. Meyer AA, Messick WJ, Young P, et al. Prospective comparison of clinical judgement and APACHE II score in predicting the outcome in critically ill surgical patients . J Trauma . 1992;32:747-753.Crossref 15. Larvin M, McMahon MJ. APACHE II score for assessment and monitoring of acute pancreatitis . Lancet . 1989;2:201-203.Crossref 16. Giangiulani G, Gui D, Bonatti P, et al. APACHE II in surgical lung carcinoma patients . Chest . 1990;100:590-591.Crossref 17. Turner JS, Mudliar YM, Chang RW, et al. Acute physiology and chronic health evaluation (APACHE II) scoring in a cardiothoracic intensive care unit . Crit Care Med . 1991;19:1266-1269. 18. Gagner M, Franco D, Vons C, et al. Analysis of morbidity and mortality rates in right hepatectomy with the preoperative APACHE II score . Surgery . 1991; 110:487-492. 19. Edwards AT, Ng KG, Shandall AA, et al. Experience with the APACHE II severity of disease scoring system in predicting outcome in a surgical intensive care unit . J R Coll Surg Edinb . 1991;36:37-40. 20. Borlase BC, Baxter JK, Kenney PR, et al. Elective intrahospital admissions versus acute interhospital transfers to a surgical intensive care unit: cost and outcome prediction . J Trauma . 1991;31:915-918.Crossref 21. Hoepfl AW, Taaffe CL, Herrmann VM. Failure of APACHE II alone as a predictor of mortality in patients receiving total parenteral nutrition . Crit Care Med . 1989;17:414-417.Crossref 22. Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of APACHE II for cost containment and quality assurance . Ann Surg . 1990;212:266-274.Crossref 23. Civetta JM, Hudson-Civetta JA, Kirton O, et al. Further appraisal of APACHE II limitations and potential . Surg Gynecol Obstet . 1992;175:195-203. 24. Boyd O. Grounds RM. Physiological scoring systems and audit . Lancet . 1993; 341:1573-1574.Crossref 25. Berger MM, Marazzi A, Freeman J, et al. Evaluation of the consistency of Acute Physiology and Chronic Health Evaluation (APACHE II) scoring in a surgical intensive care unit . Crit Care Med . 1992;20:1681-1687.Crossref 26. Vassar MJ, Wilkerson CL, Duran PJ, et al. Comparison of APACHE II, TRISS, and a proposed 24-hour ICU point system for prediction of outcome in ICU trauma patients . J Trauma . 1992;32:490-499.Crossref 27. Brown JJ, Sullivan G. Effect on ICU mortality of a full-time critical care specialist . Chest . 1989;96:127-129.Crossref 28. Marsh HM, Krishan I, Naessens JM, et al. Assessment of prediction of mortality by using the APACHE II scoring system in intensive care units . Mayo Clin Proc . 1990;65:1627-1629.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Comparison of APACHE II and III Scoring Systems for Mortality Prediction in Critical Surgical Illness

Archives of Surgery , Volume 130 (1) – Jan 1, 1995

Loading next page...
 
/lp/american-medical-association/comparison-of-apache-ii-and-iii-scoring-systems-for-mortality-z6Mbhb1HEP
Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430010079016
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness. Design: Prospective cohort study. Setting: Surgical intensive care unit of an urban, tertiary-care university hospital. Participants: Eight hundred forty-four consecutive patients in the surgical intensive care unit. Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups. Main Outcome Measures: Survival to hospital discharge, and survival compared with published normative APACHE II and III databases. Results: Mean age was 65.1 ±0.5 years. Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital. The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P<.0001) (range of correlation coefficients,.72 to.86) overall and in all subgroups. Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P<.01) higher overall and in all subgroups. Conclusions: In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.(Arch Surg. 1995;130:77-82) References 1. Frey CF, Suzuki M, Isaji S, et al. Assessment of severity of critical illness . In: Barie PS, Shires GT, ed. Surgical Intensive Care . Boston, Mass: Little Brown & Co; 1993:3-46. 2. Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE acute physiology and chronic health evaluation: a physiologically based classification system . Crit Care Med . 1981;9:951-956. 3. Knaus WA, Draper EA, Wagner DA, et al. An evaluation of outcomes from intensive care in major medical centers . Ann Intern Med . 1986;104:410-415.Crossref 4. Knaus WA, Draper EA, Wagner DP, et al. APACHE-II: a severity of disease classification system . Crit Care Med . 1985;13:818-824.Crossref 5. Bohnen JM, Mustard RA, Oxholm SE, et al. APACHE II score and abdominal sepsis . Arch Surg . 1988;123:225-229.Crossref 6. Headley J, Thierault R, Smith TL, Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit . Cancer . 1992;70:497-503.Crossref 7. Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients . Arch Surg . 1990;125: 519-524.Crossref 8. McAnena OJ, Moore FA, Moore EE, et al. Invalidation of the APACHE II scoring system for patients with acute trauma . J Trauma . 1992;33:504-506.Crossref 9. Sleigh JW, Brook RJ, Miller M. Time-dependent error in the APACHE II scoring system . Anaesth Intensive Care . 1992;20:63-65. 10. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults . Chest . 1991;100:1619-1636.Crossref 11. Knaus WA, Wagner DP, Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics . Science . 1991;254:389-394.Crossref 12. Holt AW, Bury LK, Bersten AD, et al. Prospective evaluation of residents and nurses as severity score data collectors . Crit Care Med . 1992;20:1688-1691.Crossref 13. Christou NV, Barie PS, Dellinger EP, et al. Surgical Infection Society intraabdominal infection study: prospective evaluation of management techniques and outcome . Arch Surg . 1993;128:193-198.Crossref 14. Meyer AA, Messick WJ, Young P, et al. Prospective comparison of clinical judgement and APACHE II score in predicting the outcome in critically ill surgical patients . J Trauma . 1992;32:747-753.Crossref 15. Larvin M, McMahon MJ. APACHE II score for assessment and monitoring of acute pancreatitis . Lancet . 1989;2:201-203.Crossref 16. Giangiulani G, Gui D, Bonatti P, et al. APACHE II in surgical lung carcinoma patients . Chest . 1990;100:590-591.Crossref 17. Turner JS, Mudliar YM, Chang RW, et al. Acute physiology and chronic health evaluation (APACHE II) scoring in a cardiothoracic intensive care unit . Crit Care Med . 1991;19:1266-1269. 18. Gagner M, Franco D, Vons C, et al. Analysis of morbidity and mortality rates in right hepatectomy with the preoperative APACHE II score . Surgery . 1991; 110:487-492. 19. Edwards AT, Ng KG, Shandall AA, et al. Experience with the APACHE II severity of disease scoring system in predicting outcome in a surgical intensive care unit . J R Coll Surg Edinb . 1991;36:37-40. 20. Borlase BC, Baxter JK, Kenney PR, et al. Elective intrahospital admissions versus acute interhospital transfers to a surgical intensive care unit: cost and outcome prediction . J Trauma . 1991;31:915-918.Crossref 21. Hoepfl AW, Taaffe CL, Herrmann VM. Failure of APACHE II alone as a predictor of mortality in patients receiving total parenteral nutrition . Crit Care Med . 1989;17:414-417.Crossref 22. Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of APACHE II for cost containment and quality assurance . Ann Surg . 1990;212:266-274.Crossref 23. Civetta JM, Hudson-Civetta JA, Kirton O, et al. Further appraisal of APACHE II limitations and potential . Surg Gynecol Obstet . 1992;175:195-203. 24. Boyd O. Grounds RM. Physiological scoring systems and audit . Lancet . 1993; 341:1573-1574.Crossref 25. Berger MM, Marazzi A, Freeman J, et al. Evaluation of the consistency of Acute Physiology and Chronic Health Evaluation (APACHE II) scoring in a surgical intensive care unit . Crit Care Med . 1992;20:1681-1687.Crossref 26. Vassar MJ, Wilkerson CL, Duran PJ, et al. Comparison of APACHE II, TRISS, and a proposed 24-hour ICU point system for prediction of outcome in ICU trauma patients . J Trauma . 1992;32:490-499.Crossref 27. Brown JJ, Sullivan G. Effect on ICU mortality of a full-time critical care specialist . Chest . 1989;96:127-129.Crossref 28. Marsh HM, Krishan I, Naessens JM, et al. Assessment of prediction of mortality by using the APACHE II scoring system in intensive care units . Mayo Clin Proc . 1990;65:1627-1629.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1995

References