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Editorials |

Timing Is Everything

Thomas L. Higgins, MD, MBA
Author and Funding Information

Affiliations: Springfield, MA
 ,  Dr. Higgins is Chief of the Division of Critical Care, Baystate Medical Center, and Associate Professor of Medicine and Anesthesiology, Tufts University School of Medicine.

Correspondence to: Thomas L. Higgins, MD, MBA, Division of Critical Care, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199; e-mail: thomas.higgins@bhs.org



Chest. 2004;126(1):4-6. doi:10.1378/chest.126.1.4
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Clinical outcomes in patients with severe sepsis are of great interest, particularly when new interventions (pharmaceutical, clinical management, or organizational) are applied and results compared with conventional therapy. Crude mortality rates are highly variable with severe sepsis, as with many critical illnesses. Clinicians have come to recognize the impact of age, preexisting medical conditions, and physiologic reserve in adjusting outcome observations. Independent (input) variables can be quantified to better interpret outcomes using tools such as APACHE (acute physiology and chronic health evaluation),1 the mortality probability model (MPM),2 the simplified acute physiology score,3 or equations customized for the sepsis population.4 While the concept of using a retrospective scoring system to determine therapy remains controversial, the US Food and Drug Administration chose to recommend use of an APACHE II severity score as one of the criteria for administration of activated protein C in sepsis.5

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