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Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness
P S Barie1, L J Hydo, E Fischer
1Department of Surgery, Cornell University Medical College, New York Hospital-Cornell Medical Center, NY.
Objective:
To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness.
Design:
Prospective cohort study.
Setting:
Surgical intensive care unit of an urban, tertiary-care university hospital.
Participants:
Eight hundred forty-four consecutive patients in the surgical intensive care unit. Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups.
Main Outcome Measures:
Survival to hospital discharge, and survival compared with published normative APACHE II and III databases.
Results:
Mean age was 65.1 +/- 0.5 years. Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital. The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P < .0001) (range of correlation coefficients, .72 to .86) overall and in all subgroups. Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P < .01) higher overall and in all subgroups.
Conclusions:
In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.