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Related Experiment Videos

Inter-observer variability in APACHE II scoring: effect of strict guidelines and training.

K H Polderman1, E M Jorna, A R Girbes

  • 1Surgical Intensive Care Unit, University Hospital Vrije Universiteit, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. k.polderman@azvu.nl

Intensive Care Medicine
|August 21, 2001
PubMed
Summary

Implementing strict guidelines and training significantly reduced variability in Acute Physiology and Chronic Health Evaluation (APACHE II) scoring, especially for experienced physicians. Some scoring variability, however, appears inherent to the APACHE II system.

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Area of Science:

  • Critical Care Medicine
  • Health Services Research

Background:

  • The Acute Physiology and Chronic Health Evaluation (APACHE II) is a widely used scoring system for assessing patient severity in intensive care units.
  • Variability in APACHE II scoring can impact clinical decision-making and research outcomes.

Purpose of the Study:

  • To evaluate the impact of standardized guidelines and a comprehensive training program on interobserver variability in APACHE II scoring.
  • To identify factors influencing the effectiveness of interventions aimed at reducing scoring variability.

Main Methods:

  • A prospective survey and intervention study was conducted in a university teaching hospital's surgical intensive care unit.
  • Seven experienced intensivists and nine residents performed APACHE II scoring before and after a 4-month rigorous training program and adherence to strict guidelines.

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Main Results:

  • Interobserver agreement for APACHE II scores increased from 59.7% to 76.5%, and reliability (weighted kappa) improved from 0.72 to 0.85 post-intervention.
  • The training program demonstrated greater benefits for experienced intensivists compared to residents, suggesting a differential impact based on prior experience.

Conclusions:

  • Strict guidelines and regular training markedly decrease interobserver variability in APACHE II scoring, particularly among experienced clinicians.
  • A residual 10-15% variability in APACHE II scoring persists even among experienced physicians, indicating potential inherent limitations of the scoring system.