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Outcome evaluation in a surgical intensive care unit in Barbados
S Hariharan1, H S L Moseley, A Y Kumar
1Department of Anaesthesia and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados.
Anaesthesia
|April 23, 2002
Summary
The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system accurately predicted mortality in Barbados. This surgical intensive care unit study found comparable outcomes and significantly lower costs than in North America.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Surgical Outcomes
Background:
- The Acute Physiology and Chronic Health Evaluation II (APACHE II) is a widely used scoring system for predicting patient mortality in intensive care units.
- Validating the performance of scoring systems in diverse healthcare settings is crucial for their effective application.
- The Queen Elizabeth Hospital in Barbados serves a population that may differ demographically and economically from those in developed countries where such systems are often validated.
Purpose of the Study:
- To prospectively evaluate the performance of the APACHE II scoring system in a surgical intensive care unit (SICU) in Barbados.
- To compare the predicted mortality rates generated by APACHE II with observed mortality.
- To assess the economic implications by comparing patient costs in Barbados with those in North America.
Main Methods:
- A prospective study involving 309 consecutive patients admitted to the SICU at the Queen Elizabeth Hospital, Barbados, between 1999 and 2001.
- Data collected included demographic information, diagnosis, APACHE II scores, duration of stay, and hospital outcome (mortality).
- Predicted mortality and patient costs were calculated for each patient.
Main Results:
- The overall observed mortality rate was 15.9%.
- The mean predicted mortality rate for the patient cohort was 16.4%, demonstrating good agreement between predicted and observed outcomes.
- Patient costs in Barbados ($13,636) were substantially lower than reported costs in North America ($60,000).
Conclusions:
- The APACHE II scoring system demonstrates comparable performance in predicting mortality in the SICU at the Queen Elizabeth Hospital, Barbados, to that reported in developed countries.
- The findings suggest that established critical care scoring systems can be effectively utilized in resource-limited settings.
- The study highlights significant cost-effectiveness in managing SICU patients in Barbados compared to North America.