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[Severity assessment by APACHE III system in Spain]
G Vázquez Mata1, M del Mar Jiménez Quintana, R Rivera Fernández
1Proyecto PAEEC, Proyecto de Análisis Epidemiológico de Enfermos Críticos, Granada, Spain.
Medicina Clinica
|October 25, 2001
Summary
The Acute Physiology Age and Chronic Health Evaluation (APACHE) III score accurately predicted mortality in Spanish intensive care units. While generally effective, slight calibration differences were noted, potentially due to case-mix variations.
Area of Science:
- Critical care medicine
- Prognostic modeling
- Health services research
Context:
- The Acute Physiology Age and Chronic Health Evaluation (APACHE) III is a widely used prognostic scoring system in intensive care units (ICUs).
- Its performance may vary across different healthcare systems and patient populations.
- Validating prognostic tools in local contexts is crucial for accurate patient management.
Purpose:
- To evaluate the predictive performance of the APACHE III scoring system in a Spanish cohort.
- To assess the calibration and discrimination of the APACHE III equation for hospital mortality prediction in Spanish ICUs.
Summary:
- A prospective multicenter study included 10,786 adult patients from 86 Spanish ICUs.
- Observed hospital mortality was 21.2%, while APACHE III predicted 19.8% (Standardized Mortality Ratio 1.07).
- The model showed good discrimination (Area Under ROC Curve: 0.808) but had minor calibration discrepancies, particularly for higher risk categories.
Impact:
- The APACHE III equation demonstrates good applicability to Spanish critical care patients, with minor limitations.
- Findings suggest potential impact of case-mix and practice style variations on prediction accuracy.
- This validation supports the continued use of APACHE III in Spain while highlighting areas for potential refinement.