A number of physiologic scoring systems have been developed worldwide for estimating outcomes of critically ill patients. Using the Apache II system, we attempted to determine disease severity and outcome of critically ill patients and to assess their relationship to the clinical characteristics of the population admitted to the Medical Intensive Care Unit (MICU). This data was then compared with a similar study done in the same ICU 10 years ago.
Prospective survey of 60 patients admitted to the MICU at Harlem Hospital over 2 months. The Apache II scores were evaluated at 24 and 48 hours and hospital outcomes were assessed.
There were 22(36.6%) females and 38(63.3%) males; Age range 18 –92 yrs(mean 58.2). Five patients(8.3%) had HIV infection and 39(65%) had three or more co-morbidities. The Apache II scores ranged from 4–36(mean 18.6) at 24hrs, and 0-39(mean 16.8) at 48hrs. The length of ICU stay ranged from 1–42 days(average 8 days); 46 patients(76.6%) stayed for 10 days or less(average 3.6 days). Eighteen patients(30%) died in the hospital with Apache II scores of 9-39; 23% women and 34% men died. Twelve(20%) deaths occurred in ICU. The Apache II scores of survivors were 0-29. However the average scores of survivors versus(vs)non-survivors were significantly different (Graphic 1): at 24 hours 16.4 vs 24 (p = 0.0004); at 48 hours 14.5 vs 22.4 (p = 0.0006). In the similar study done previously in this population, more than 80% had significant co-morbidities; 20% had HIV infection. But the average Apache II scores at 24hrs and 48hrs of survivors vs non-survivors were not significantly different.
In our patients, Apache II scores of survivors versus non-survivors were significantly different overall. However in individual patients the scores were not always predictive of the outcome.
As the cost of ICU care continues to rise and with the decline of available resources, improving our ability to accurately predict the outcome of critically ill patients is crucial.
APACHE II SCORES OF SURVIVORS VS NON-SURVIVORSSurvivorsNon-SurvivorsP ValueAt 24 hrsMean16.4240.0004Males1724Females1625At 48 hrsMean14.522.40.0006Males1520Females1428
V.E. Coelho-D’Costa, None.