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APACHE II scoring in the injured patient
K J Rhee1, W G Baxt, J R Mackenzie
1Division of Emergency Medicine, University of California Davis Medical Center, Sacramento 95817.
Critical Care Medicine
|August 1, 1990
Summary
The Acute Physiology and Chronic Health Evaluation (APACHE II) score effectively predicts mortality in severely injured patients. Trauma Score (TS) and Injury Severity Score (ISS) also show predictive power, complementing APACHE II.
Area of Science:
- Trauma care
- Medical scoring systems
- Prognostic modeling
Background:
- Accurate mortality prediction is crucial for managing severely injured patients.
- Established scoring systems like APACHE II, TS, and ISS aid in risk stratification.
Purpose of the Study:
- To evaluate the predictive accuracy of APACHE II for mortality in helicopter-transported trauma patients.
- To compare the predictive performance of APACHE II against the Trauma Score (TS) and Injury Severity Score (ISS).
Main Methods:
- Analysis of 691 helicopter-transported patients with severe injuries.
- Individual and stepwise logistic regression analyses were performed for each scoring system.
- Receiver operating characteristic (ROC) curve analysis was used to compare predictive performance.
Main Results:
- All three scores (TS, APACHE II, ISS) demonstrated significant individual predictive power for mortality.
- Each scoring system significantly enhanced predictive accuracy when added stepwise in logistic regression models.
- Areas under the ROC curves showed APACHE II (0.8515) slightly outperforming TS (0.8116) and ISS (0.7967), though differences were not statistically significant.
Conclusions:
- APACHE II is a robust predictor of mortality in severely injured patients.
- TS and ISS provide complementary prognostic information, enhancing the overall predictive capability when used with APACHE II.