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Rapid acute physiology scoring in transport systems.
K J Rhee1, J R Mackenzie, R E Burney
1Division of Emergency Medicine, University of California Davis Medical Center, Sacramento 95817.
Critical Care Medicine
|October 1, 1990
Summary
The Rapid Acute Physiology Score (RAPS) reliably predicts mortality in transported patients. This score, a modified APACHE II, offers consistent assessment before and after transport for critical care.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Health Services Research
Background:
- Assessing patient severity in pre-hospital and transport settings is crucial.
- Existing scoring systems may not be optimized for dynamic physiological changes during transport.
Purpose of the Study:
- To evaluate the predictive accuracy of the Rapid Acute Physiology Score (RAPS) for mortality in a large cohort of transported patients.
- To compare RAPS with the Acute Physiology and Chronic Health Evaluation (APACHE II) score.
Main Methods:
- A multi-institutional study involving 1,927 patients transported by helicopter emergency medical services over 8 months.
- RAPS was calculated before and after transport; APACHE II was calculated post-admission.
- Receiver operating characteristic (ROC) curves were used to assess predictive power for mortality.
Main Results:
- RAPS demonstrated high predictive power for mortality, comparable to APACHE II when using the most deranged physiological values within 24 hours post-admission.
- Both before- and after-transport RAPS scores were highly predictive of patient mortality.
- Over 97% of patients had RAPS assessed pre- and post-transport, and 92.6% had APACHE II completed.
Conclusions:
- RAPS is a reliable and potent tool for assessing patient severity and physiological stability during pre-hospital transport and upon arrival at a critical care facility.
- RAPS offers a valuable, consistent measure for clinicians managing critically ill patients during inter-facility transfers.