Validation of the APACHE II Scoring System as a Prognostic Tool in Patients Admitted to the Emergency Room at a...

The APACHE II scoring system is one of the most widely used systems to predict mortality in critically ill patients. However, its performance may differ across settings and, importantly, in low- and middle-income countries. It guarantees simplicity, reproducibility, and applicability to various clinical scenarios.

The present study aimed to find out the predictive accuracy of the APACHE II score for in-hospital mortality in patients admitted through the emergency room of the tertiary care hospital.

A retrospective observational cohort study was conducted over 3 months in the ER of a tertiary care center. Adults (≥18 years) admitted through the ER with complete physiological and laboratory data within the first 24 h, allowing the calculation of APACHE II were extracted from the medical records, and patients were followed until discharge or in-hospital death. Receiver operating characteristic analysis was used to describe the predictive performance of APACHE II for mortality.

Out of the 75 patients, 27 (36%) died while they were being hospitalized, whereas 48 (64%) patients were discharged. The mean APACHE II score was significantly higher among nonsurvivors as compared to survivors (24.6 ± 7.1 vs. 11.6 ± 7.0; P < 0.001). The area under the curve was 0.89, reflecting excellent predictive accuracy.

The APACHE II scoring system was found to have a good discriminative power in predicting mortality among ER admissions at the present tertiary care center. The early application of this tool may support more effective risk stratification and be used to guide clinical decisions in emergency care.