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At least 217 records · Page 12Linked to original sources
PubMed1999

Severity and prognosis in intensive care: prospective application of the APACHE II index.

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28. 5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

APACHE↗
PubMed2005

Apache II score as a predictor of length of stay and outcome in our ICUs.

The APACHE II (acute physiology and chronic health evaluation) is used widely for predicting probability of hospital mortality and length of stay in the ICU. APACHE II forms were available to all ICU residents within 24 hours of admission, and a score was assigned to them. Based on our results the APACHE II score has reliably predicted an outcome of the least amount of length of stay (LOS) in the ICU as well as a 100% probability of being shifted out of the ICU for a score of < 10 (according to international benchmarks). This reliable scoring system can be used for predicting mortality and length of stay and therefore, resource allocation, antibiotic use and ethical decisions regarding counseling families about end of life decisions--all within 24 hours of admissions.

APACHE↗
PubMed1995

The use of APACHE III to evaluate ICU length of stay, resource use, and mortality after coronary artery by-pass surgery.

OBJECTIVE: To identify patient characteristics that are associated with increased ICU length of stay, resource use, and hospital mortality after coronary artery bypass surgery. DESIGN: Prospective, multicenter study. SETTING: Six tertiary care hospitals. PARTICIPANTS: A consecutive sample of 2,435 unselected ICU admissions following coronary artery by-pass surgery. MATERIALS AND METHODS: Demographic, operative characteristics and APACHE III score were collected during the first postoperative day; and APACHE III scores and therapeutic interventions during the first three postoperative days. Hospital survival and ICU length of stay were also recorded. Multivariate equations were derived and cross-validated to predict hospital mortality, ICU length of stay, and ICU resource use. RESULTS: Unadjusted hospital mortality rate was 3.9% (range 1.0% to 6.0%), mean ICU length of stay was 3.7 days (range 3.2 to 4.7 days), and first 3-day ICU resource use (TISS points) was 99 (range 68 to 116). The range of actual to predicted ICU length of stay varied from 0.86 to 1.26; and resource use from 0.71 to 1.16. CONCLUSIONS: A limited number of operative characteristics, the post-operative acute physiology score (APS) of APACHE III and patient demographic data can predict hospital death rate, ICU length of stay, and resource use immediately following coronary by-pass surgery. These estimates may compliment assessments based on pre-operative risk factors in order to more precisely evaluate and improve the efficacy and efficiency of cardiovascular surgery.

APACHE↗
PubMed1997

[Apache II score and prognosis of intensive care patients after trauma--results of a quality assurance study of 939 patients].

The APACHE II score is a well-known measure of illness severity and widely used for prognosis in the ICU. A total of 91 trauma patients were identified among 939 ICU admissions (18 months), and their actual mortality (11/91; 12.1%) clearly exceeds the prognosis due to APACHE II (7.1%). Trauma-specific scores (TRISS, ISS, and RTS) revealed much higher estimates: 13%-22% which confirms a systematic underestimation of risk of death score in trauma patients in the APACHE system.

APACHE↗
PubMed1990

APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients.

A clinical study was undertaken to evaluate the ability of the APACHE (acute physiology and chronic health care) II system to predict the development of multiple organ failure syndrome and subsequent mortality. The study was conducted in a university general surgery intensive care unit using the admission APACHE II score. Over a 1-year period, 92 patients qualified for the study, 24 of whom survived, 69 of whom suffered multiple organ failure syndrome, and 68 of whom died. The APACHE II score did not predict the development of multiple organ failure syndrome or mortality with clinical utility and significantly underestimated the potential for the development of multiple organ failure syndrome. Factors that did predict the development of multiple organ failure syndrome and mortality were the time-dependent changes in the PaO2-to-fraction of inspired oxygen ratio and serum lactate, creatinine, and bilirubin levels. Better markers of cell injury are needed for use in decision making and quality assurance analysis in surgical patients.

Humans↗
PubMed1989

APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: prognostic value and potential clinical applications.

This study examined the prognostic value of the APACHE II scoring system in patients undergoing emergency operations for bleeding peptic ulcer. There were 96 operations for gastric ulcers and 58 for duodenal ulcers. The mean scores in survivors and in patients who died were 10.8 and 17.5 respectively. None of the 66 patients with an APACHE II score less than 11 died, while the mortality rate in those scored greater than 10 was 22 per cent. In patients scored greater than 10 non-resective procedures carried less risk of mortality than gastrectomy. The APACHE II score is useful when measuring the severity of the acute disease and predicting the outcome in these patients. If used in daily practice it may assist the surgeon in stratifying patients into a low-risk group (score less than 11) in which major operations are well tolerated and outcome is favourable and a high-risk group (score greater than 10) in which the risk of mortality is high and the performance of procedures of lesser magnitude is probably more likely to improve survival.

Duodenal Ulcer↗
PubMed1992

Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit.

POSSUM and APACHE II scores from 117 consecutive admissions to a high-dependency unit after major surgery were correlated with 30-day morbidity and mortality rates. Thirteen patients (11 per cent) died and 59 (50 per cent) developed a postoperative complication. Receiver-operating characteristic curve analysis showed POSSUM to have good predictive value for mortality (area under curve 0.75) and morbidity (area under curve 0.82). APACHE II scores had a significantly inferior predictive value for mortality (area under curve 0.54) (P < 0.002). POSSUM was superior to APACHE II in prediction of mortality in patients admitted to a high-dependency unit after general surgery. Prediction of postoperative complications by POSSUM is accurate and may be useful for audit.

Adult↗
PubMed1988

Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system.

608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. The mean Apache II scores for survivors (396) and non-survivors (187) were 13 (SD 7) and 24 (SD 9), and their Risk of Death were 16 (SD 16) and 47 (SD 27) respectively (p less than 0.001 for both). The majority of deaths (75%: 141/187) in our series came from those with chronic ill health (55%: 103/187), of whom 37% (38/103) were in endstage disease, and those with "old" trauma (18%: 34/187) often with incipient sepsis transferred from other hospitals after a mean delay of 9 days. Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.

Adult↗
PubMed1989

Validation of a severity of illness score (APACHE II) in a surgical intensive care unit.

The intensive care unit is an important resource for the treatment of patients needing medical and surgical care for complicated diseases. The diversity of diseases and the difference in arrangements between hospitals providing such care have limited the precision of evaluations of intensive care. We have measured the admission characteristics and hospital mortality of 598 consecutive patients admitted to our Surgical Intensive Care Unit (SICU) using a severity of disease classification system (APACHE II) on the first day of admission. Hospital outcome details were available on 87% of the SICU patients. The overall mortality was 21.7%, mean APACHE score for survivors and non-survivors was 14.2 and 22.4, and their risk of death was 21.1% and 54.1%. The APACHE II scoring system provided an excellent means of classification, with a higher sensitivity and specificity.

Female↗
PubMed1991

Predicting outcome in intensive therapy units--a comparison of Apache II with subjective assessments.

In a prospective study 568 patients admitted to a mixed medical and surgical intensive therapy unit (ITU) were assessed using the Apache II severity of illness score to predict outcome. Their outcome was also predicted subjectively by a doctor and nurse on admission. There were 260 deaths in the group. The subjective predictions were compared with the Apache II predictions using logistic regression analysis and receiver-operating-characteristic curve measurement. The subjective assessments were found to be a more powerful predictor of outcome in this group of patients than the Apache II scores and predicted risk of death. Although the predictions could be successfully applied to the population as a whole, none of the tests were suitable for predicting outcome on an individual patient.

Decision Making↗
PubMed1992

Early prediction of septic complications after cardiac surgery by APACHE II score.

In 110 patients admitted to the intensive care unit after cardiac surgery, daily monitoring [clinical parameters, cardiac index (CI), left ventricular stroke work index (LVSWI) and APACHE II score] was performed in regard to its usefulness in the early prediction of septic complications, a major cause of postoperative mortality. Septic complications (defined as Elebute sepsis score of > or = 12 on > or = 2 days) occurred in 16 patients and were associated with a significantly worse prognosis (mortality 69% vs 1%, P < 0.0001) than was seen in patients without sepsis. While preoperative APACHE II score values did not differentiate between the patients with an uneventful postoperative course and those with septic complications, patients who ultimately developed septic complications had significantly (P < 0.001) higher scores as early as on the evening of the operation day ("day 0"). In addition, in contrast to patients without sepsis, whose scores dropped markedly (P < 0.001) between day 0 and day 1, patients with septic complications invariably had high scores. Compared to single parameters (fever, leucocyte count, CI, LVSWI), the APACHE II score proved to be superior in differentiating between patients who developed sepsis and those who did not. A score of 19 or more on the 1st postoperative day had a sensitivity of 75%, a specificity of 98%, a Youden index of 0.73, a positive predictive value of 86%, and a negative predictive value of 96% in regard to prediction of septic complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1990

APACHE II in emergency operations for perforated ulcers.

Most reports concerning the management of patients with perforated peptic ulcers suffer from inadequate documentation of the severity of illness and the operative risk of these patients. This study attempts to evaluate the prognostic value of the APACHE II scoring system in a homogeneous group of patients with perforated peptide ulcers, to assess it as a potential clinical and research tool for future studies, and to examine its usefulness in stratifying these patients according to their surgical risk. Our results confirm the prognostic value of the APACHE II scoring system, measured either retrospectively or prospectively, in patients who undergo emergency operations for perforated ulcers. When measured preoperatively, it accurately stratifies these patients to various risk groups and should therefore be used in future trials examining various treatment aspects of this condition. Our data, evaluating the results of various procedures in subgroups of patients stratified by the APACHE II, failed to support the superiority of one approach over another.

Duodenal Ulcer↗
PubMed1990

Assessment of prediction of mortality by using the APACHE II scoring system in intensive-care units;.

Some investigators have suggested that information on quality of care in intensive-care units (ICUs) may be inferred from mortality rates. Specifically, the ratio of actual to predicted hospital mortality (A/P) has been proposed as a valid measure for comparing ICU outcomes when predicted mortality has been derived from data collected during the first 24 hours of ICU therapy with use of a severity scoring tool, APACHE II (acute physiology and chronic health evaluation). We present a comparison of mortality ratios (A/P) in four ICUs under common management, in two hospitals within a single institution. Significant differences in A/P were detected for nonoperative patients (0.99 versus 0.67;P = 0.014) between the two hospitals. This variation was traced to uneven representation of a subset of patients who had chronic health problems related to diseases that necessitated admission to the hematology-oncology or hepatology service. No differences in A/P were seen between the two hospitals for operative patients or for nonoperative patients on services other than hematology-oncology or hepatology. Thus, differences in A/P detected by using the APACHE II system not only may reside in operational factors within the ICU organization but also may be related to weaknesses in the APACHE II model to measure factors intrinsic to the disease process in some patients. We suggest that case-mix must be examined in detail before concluding that differences in A/P are caused by differences in quality of care.

Diagnosis-Related Groups↗
PubMed1986

Use of APACHE II severity of disease classification to identify intensive-care-unit patients who would not benefit from total parenteral nutrition.

The APACHE II severity of disease classification system was tested for its ability to identify intensive-care-unit (ICU) patients who would not benefit from treatment with total parenteral nutrition (TPN). First, the classification was validated in our patient population by testing it on 210 consecutive ICU admissions. Then a retrospective study was done on 89 ICU patients who had received TPN, to define APACHE II selection criteria. When the APACHE II system was tested prospectively on 26 ICU patients treated with TPN, it predicted correctly, with a specificity of 100%, half of the patients who died.

Adult↗
PubMed1992

Prevention of Haemophilus influenzae type b infections in Apache and Navajo children.

Prospective surveillance of Haemophilus influenzae type b (Hib) disease has been done since 1981 in two high-risk populations, White Mountain Apaches and Navajos. The attack rate in children less than 5 years of age is 5-10 times higher than in the general US population. Three vaccines were evaluated. Unconjugated Hib capsular polysaccharide produced lower antibody responses in 18- and 24-month-old Apache infants than in white infants. HbOC (Hib oligosaccharide covalently linked to the nontoxic mutant diphtheria toxin CRM197) produced low antibody responses in Navajo infants after one or two doses but induced responses similar to those in whites after three doses. The responses of 18-month-old Navajos to HbOC were lower than those of whites, but most achieved protective levels. PRP-OMP (Hib capsular polysaccharide linked to the outer membrane protein complex of Neisseria meningitidis) produced good immune responses in 2-month-old Navajo and Apache infants after a single dose. This vaccine was greater than 90% efficacious in protecting Navajo infants from Hib disease when given at 2 and 4 months of age. Even a single dose achieved a high protective efficacy.

Antibodies, Bacterial↗
PubMed1991

APACHE II: prediction of outcome of 451 ICU oncology admissions in a community hospital.

The APACHE II system has been shown to be a reliable and useful means of evaluating patient outcome from the intensive care unit when applied to a broad spectrum of diagnoses. The major purpose of this study was to determine the use of APACHE II as a means of predicting outcome of ICU oncology patients. Data were retrospectively collected for 451 ICU oncology admissions. A direct relationship between severity of physiologic derangement and patient risk of death was demonstrated. Patients with scores of 30 or greater had hospital mortality rates of 100% for postoperative and 92.6% for nonoperative patients. The APACHE II was a useful means of predicting the outcome of ICU oncology patients. This potentially provides the patient, family, and physician an objective dimension in making decisions whether to transfer the oncology patient.

Adolescent↗
PubMed1986

Stratification of prognosis in granulocytopenic patients with hematologic malignancies using the APACHE-II severity of illness score.

The APACHE-II (acute physiology and chronic health evaluation) severity of disease classification system was used to stratify prognosis of granulocytopenic patients with hematologic malignancies. A total of 146 admissions were retrospectively reviewed. In 26 ICU admissions, mortality was 69.2%; in 120 admissions to the ward, mortality was 15.8%. The APACHE-II score successfully stratified prognosis in both ward and ICU settings. Respiratory failure and the presence of pneumonia on chest x-ray were identified as poor prognostic factors. ICU patients admitted for monitoring or postoperative care had a better prognosis than those admitted for severe cardiopulmonary compromise. We suggest that the APACHE-II system is useful for stratifying prognosis for clinical research in this group of patients, although it remains to be shown whether it will be useful in predicting the prognosis of individual patients.

Adolescent↗
PubMed1989

Failure of APACHE II alone as a predictor of mortality in patients receiving total parenteral nutrition.

We followed prospectively over 5 months all medical and surgical ICU patients placed on total parenteral nutrition (TPN) and recorded their Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on the day of admission, on the day TPN was started, length of time in ICU before TPN was started, and the number of days TPN was administered. Sixty-one patients (15 to 82 yr) had an inhospital mortality of 47%. The APACHE II score was significantly higher for nonsurvivors vs. survivors both on the day of admission (24.4 +/- 9.6 vs. 18.4 +/- 6.5; p less than .003) and also on the day TPN was started (21 +/- 8.6 vs. 16.4 +/- 5.6; p less than .002). However, at a 60% risk of dying, specificity was 96.9% and sensitivity 27.6%. The mean number of days before TPN was started was 3.2 and mean number of days on TPN was 9.2 (p = NS). We conclude that calculation of APACHE II score either on ICU admission or on the day TPN is considered does not seem useful in identifying patients who will not benefit from TPN.

Adolescent↗