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Risk-adjusted outcome evaluation in a multidisciplinary intensive care unit.
S Hariharan1, L Merritt-Charles, D Chen
1Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago, West Indies. uwi.hariharan@gmail.com
The West Indian Medical Journal
|December 13, 2007
Summary
This study evaluated the Acute Physiology and Chronic Health Evaluation (APACHE II) and Paediatric Index of Mortality (PIM-2) scoring systems in a multidisciplinary ICU. Results showed fair calibration but varied discriminant ability, highlighting challenges in risk-adjusted outcome evaluation.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Biostatistics
Background:
- Multidisciplinary Intensive Care Units (ICUs) require robust methods for outcome evaluation.
- Prognostic scoring systems are crucial for risk adjustment and performance assessment in ICUs.
Purpose of the Study:
- To assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE II) and Paediatric Index of Mortality (PIM-2) scoring systems.
- To evaluate the risk-adjusted outcomes in a multidisciplinary ICU setting.
Main Methods:
- Prospective data collection of 217 consecutive ICU patients over one year.
- Application of APACHE II for adults and PIM-2 for children, including demographics, diagnoses, and ICU stay duration.
- Calibration and discriminant function assessed using Hosmer-Lemeshow analysis and Receiver Operating Characteristic (ROC) curves.
Main Results:
- APACHE II showed a mean score of 14.3 in adults, with significant differences between survivors and non-survivors (p < 0.0001).
- Predicted mortality by APACHE II was 16.5% (observed 19.8%); PIM-2 predicted 34.8% (observed 30%) in children.
- APACHE II demonstrated good discriminant ability (ROC AUC 0.88), while PIM-2 showed moderate ability (ROC AUC 0.62).
Conclusions:
- Both APACHE II and PIM-2 systems exhibited fair calibration.
- Evaluating risk-adjusted outcomes in multidisciplinary ICUs presents challenges due to the necessity of employing multiple prognostic scoring systems.
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