Daily Improvement in APACHE II Score (APACHE/m) and Outcomes in ICU Trauma Patients

The Acute Physiology and Chronic Health Evaluation II (APACHE II) is a widely used intensive care unit (ICU) severity score; however, it provides only an admission snapshot. Therefore, we introduced a novel metric, APACHE/m (average daily decrease in APACHE II score during ICU stay), to examine whether faster physiological improvement was correlated with better outcomes in ICU trauma patients.

This retrospective cohort study was conducted at a level I trauma center. Participants comprised 1784 adult trauma patients admitted to the ICU (2016-2023) who survived ICU discharge were included in this study. The APACHE II scores at ICU admission and discharge were recorded. APACHE/m was calculated as the decrease in APACHE II divided by the length of stay in the ICU. We analyzed the ability of APACHE/m to predict post-ICU in-hospital mortality and compared outcomes between the high and low APACHE/m groups. Propensity score matching (1:1) was used to adjust for initial injury severity and comorbidities.

Hospital mortality after ICU discharge was 2.3% (41/1784). APACHE/m alone showed poor discrimination for mortality (AUC = 0.57). In the unmatched cohort, mortality was 2.6% in high APACHE/m patients (>1.03 points/day) vs 2.0% in low APACHE/m patients (≤1.03), P = 0.523. After matching (199 pairs), high APACHE/m patients had longer hospital stays (median, 14 vs 12 days, P = 0.005) and higher mortality (3.5% vs 0%, P = 0.022) than matched low APACHE/m patients.

A rapid APACHE II score decline (high APACHE/m) did not predict improved survival in ICU trauma patients. Paradoxically, the patients with the fastest APACHE II improvements had similar or worse late outcomes, likely because they were initially more critically ill. Thus, initial severity remains an important predictor of outcomes than the ICU recovery rate.