The Acute Physiologic and Chronic Health Evaluation (APACHEII ) has been extensively used in Intensive Care Unit (ICU) setting over the past 10 years, as has been the Injury Severity Score (ISS) using an anatomical descriptive scoring . The Simplified Acute Physiology Score( IGSII ) belongs to a new generation of scoring systems : its main innovation is that the different parameters and their weighting are derived from statistical analysis. However the accuracy of APACHE II and IGSII scoring systems have to date not been specifically studied in general trauma surgical patients(TSP).To assess whether the APACHE II and IGS II scores and their derived predictors of risk of death(ROD)are applicable to TSP?.
During a16 month period TSP admitted to our ICU had APACHE II and IGSII scores with their derived ROD calculated. Receiver Operating Characteristic (ROC) curves and Goodness-of-Fit test were used to assess the accuracy of the scores.
62 TSP were included over 93 total trauma patients (median ISS score was 16.0, range 11 to 43), there were 10 in-hospital deaths from haemorrhage. The median APACHE II score was 12.0( range 0 to 40) with a mean ROD of 17.0 ± 19.6%. The median IGSII was 22.0 ( range 0 to 60) and its derived mean ROD was 15.0 ± 19.2%. The area under the ROC curves was 0.850 for the APACHE II and 0.858 for the IGS II demonstrate a good discrimination. The goodness-of-fit test indicated that both scores were well calibrated (P >0.1 for APACHE II and P >0.25 for IGSII). Standardised mortality ratio was 0.65 from APACHE II and 0.86 from IGSII.
The APACHEII and IGSII scores are both reliable and accurate in post-traumatic patients. Bleeding appeared as a poor prognostic factor.
The IGSII scoring, using actually in european ICU, could be applied in all of critical intensive care patients, including traumatics patients, improving quality of job.
Meurant Francois, None.