January 1, 2014Open Access

A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Surgical intensive care unit patients (n=202). Intervention: APACHE II scoring system vs. APACHE III and SAPS II scoring systems. Primary outcome: Discrimination (Area Under Curve) for predicting short-term hospital mortality (95% CI 0.72 to 0.93).

Key Result

The APACHE II scoring system provided excellent discrimination (AUC 0.828) and better calibration for predicting short-term hospital mortality in surgical ICU patients compared to APACHE III and SAPS II.

Study Design

Type

Observational (n=202)

Multicenter

PICO

Population

Surgical intensive care unit patients (n=202)

Intervention / Comparator

APACHE II scoring system vs APACHE III and SAPS II scoring systems

Primary Outcome

Discrimination (Area Under Curve) for predicting short-term hospital mortality (0.72 to 0.93)

Main Result

Absolute Event Rate: 0.828% vs 0.782%

Limitations

Single-centre study, which may introduce bias regarding case mix, quality of ICU care, and ICU policy
Relatively small sample size limits stratified analysis of calibration
APACHE II relies on retrospective data available within 24 hours of ICU admission, so sampling rate can influence mortality estimation

Abstract

BACKGROUND: In critically ill patients, several scoring systems have been developed over the last three decades. The Acute Physiology and Chronic Health Evaluation (APACHE) and the Simplified Acute Physiology Score (SAPS) are the most widely used scoring systems in the intensive care unit (ICU). The aim of this study was to assess the prognostic accuracy of SAPS II and APACHE II and APACHE III scoring systems in predicting short-term hospital mortality of surgical ICU patients. MATERIALS AND METHODS: Prospectively collected data from 202 patients admitted to Mashhad University Hospital postoperative ICU were analyzed. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated by using the receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). RESULT: Two hundred and two patients admitted on post-surgical ICU were evaluated. The mean SAPS II, APACHE II, and APACHE III scores for survivors were found to be significantly lower than of non-survivors. The calibration was best for APACHE II score. Discrimination was excellent for APACHE II (AUC: 0.828) score and acceptable for APACHE III (AUC: 0.782) and SAPS II (AUC: 0.778) scores. CONCLUSION: APACHE II provided better discrimination than APACHE III and SAPS II calibration was good at APACHE II and poor at APACHE III and SAPS II. Use of APACHE II was excellent in this post-surgical ICU.

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Cite This Study

Gilani et al. (Wed,) conducted a observational in Surgical intensive care unit patients (n=202). APACHE II scoring system vs. APACHE III and SAPS II scoring systems was evaluated on Discrimination (Area Under Curve) for predicting short-term hospital mortality (95% CI 0.72 to 0.93). The APACHE II scoring system provided excellent discrimination (AUC 0.828) and better calibration for predicting short-term hospital mortality in surgical ICU patients compared to APACHE III and SAPS II.

synapsesocial.com/papers/6a1552ff79ff98d0de4e71d3 https://doi.org/https://doi.org/10.4103/0300-1652.129651