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Biomedical subjects

E A Draper

Publications and source records attributed to E A Draper.

46 records · Page 3Linked to original sources
PubMed1983

Statistical validation of a severity of illness measure.

This paper provides statistical detail on the predictive power of a new severity of illness scale--APACHE (Acute Physiology and Chronic Health Evaluation)--on 833 consecutive medical admissions to an intensive care unit (ICU). In a multivariate logistic regression analysis of routine physiologic and other data obtained within 24 hours of ICU admission, severity of illness and age were significantly (p less than .0001) related to survival. Using the estimated equation to forecast death rates for independent data, APACHE allowed accurate estimates of death rates for groups of patients whose mortality at hospital discharge varied from 3 to 80 per cent. The Acute Physiology Score of APACHE is also strongly and significantly associated with outcome within a number of specific cardiovascular, neurologic, respiratory, and gastrointestinal diagnoses. After multi-institutional validation studies, APACHE could prove useful in a wide range of studies involving acutely ill patients.

Acute Disease↗
PubMed1982

Evaluating outcome from intensive care: a preliminary multihospital comparison.

To contrast mortality for groups of ICU patients treated in different hospitals, we surveyed 795 consecutive ICU admissions in 5 ICUs using a general severity of illness classification system. After obtaining information from the medical record on age, sex, indication for ICU admission, and severity of illness, we used a logistic multiple regression equation to project death rates for each ICU based on data from a sixth reference hospital. There were substantial differences in severity of acute illness among the hospitals which accounted for most of the variation in death rates. In all ICUs, however, projected death rates were quite similar to observed deaths. These findings suggest that the use of a general severity of illness index and multivariate statistical techniques could, after further refinement and validation, improve interhospital comparisons of the outcome of acutely ill patients.

Critical Care↗
PubMed1981

The range of intensive care services today.

During the past 20 years, there has been a large increase in the number of hospitals with intensive care units (ICUs). To discover what services are provided to the growing number of ICU patients, we studied 624 consecutive admissions to a general surgical-medical ICU within a university hospital. We recorded the proportion of admissions and services involving intensive treatment as opposed to concentrated nursing care or monitoring. We found that for nearly half (49%) of the admissions and during two thirds (65%) of the nursing shifts, the emphasis was on close nursing care and observation, not intensive treatment. Of 252 patients admitted for monitoring, 216 (86%) never required active treatment before discharge. The average length of stay of these 216 patients was 2.1 days. If this distribution of services and admissions within one university hospital is also found at other institutions, it suggests that a substantial portion of ICU services may now be directed at monitoring stable, noncritically ill patients.

Critical Care↗
PubMed1981

APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.

Investigations describing the utilization pattern and documenting the value of intensive care are limited by the lack of a reliable and valid classification system. In this paper, the authors describe the development and initial validation of acute physiology and chronic health evaluation (APACHE), a physiologically based classification system for measuring severity of illness in groups of critically ill patients. APACHE uses information available in the medical record. In studies on 582 admissions to a university hospital ICU and 223 admissions to a community hospital ICU, APACHE was reliable in classifying ICU admissions. In validation studies involving these 805 admissions, the acute physiology score of APACHE demonstrated consistent agreement with subsequent therapeutic effort and mortality. This was true for a broad range of patient groups using a variety of sensitivity analyses. After successful completion of multi-institutional validation studies, the APACHE classification system could be used to control for case mix, compare outcomes, evaluate new therapies, and study the utilization of ICUs.

Critical Care↗
PubMed1981

The use of intensive care: a comparison of a university and community hospital.

We compared 223 consecutive intensive care unit (ICU) admissions to a community hospital (CH) with 613 such admissions at a university hospital (UH) using a new clinical scale aimed at quantifying severity of illness. Both ICU's had similar technical resources and treatment capabilities. At the CH, however, patients were more often admitted for monitoring rather than for treatment of UH admissions had a substantially greater acute severity of illness (p less than .001) than CH patients in most diagnostic categories. These findings suggest that use of the ICU was substantially different in the two hospitals, with the CH admitting many more stable patients. This study also suggests that evaluation of ICU use is improved by quantitative measurement of severity of illness.

Costs and Cost Analysis↗