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Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in predicting hospital mortality of neurosurgical intensive care unit patients.

Park SK, Chun HJ, Kim DW, Im TH, Hong HJ, Yi HJ - J. Korean Med. Sci. (2009)

Bottom Line: SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC).Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting.TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ajou University Hospital, Suwon, Korea.

ABSTRACT
We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

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Grouped distributions of predicted risk of hospital death for APACHE II and SAPS II scores
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Figure 1: Grouped distributions of predicted risk of hospital death for APACHE II and SAPS II scores

Mentions: Observed mortality during hospital stay was 24.8% (167/672) and that during ICU stay was 21.4% (144/672). Mean APACHE II and SAPS II values were 37.74% (range: 2-39) and 38.39% (range: 15-90), respectively. Both systems were highly correlated (Bravais-Pearson correlation coefficient, 0.86, P<0.01). The mean predicted risk of death for the overall patient population, survivors and non-survivors are listed in Table 2. There was no significant difference of SMR between the two predictive scoring systems (0.66 for APACHE II and 0.65 for SAPS II). Fig. 1 depicts the distributions of predicted risks for the two systems, both of were skewed toward low scores.


Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in predicting hospital mortality of neurosurgical intensive care unit patients.

Park SK, Chun HJ, Kim DW, Im TH, Hong HJ, Yi HJ - J. Korean Med. Sci. (2009)

Grouped distributions of predicted risk of hospital death for APACHE II and SAPS II scores
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698186&req=5

Figure 1: Grouped distributions of predicted risk of hospital death for APACHE II and SAPS II scores
Mentions: Observed mortality during hospital stay was 24.8% (167/672) and that during ICU stay was 21.4% (144/672). Mean APACHE II and SAPS II values were 37.74% (range: 2-39) and 38.39% (range: 15-90), respectively. Both systems were highly correlated (Bravais-Pearson correlation coefficient, 0.86, P<0.01). The mean predicted risk of death for the overall patient population, survivors and non-survivors are listed in Table 2. There was no significant difference of SMR between the two predictive scoring systems (0.66 for APACHE II and 0.65 for SAPS II). Fig. 1 depicts the distributions of predicted risks for the two systems, both of were skewed toward low scores.

Bottom Line: SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC).Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting.TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ajou University Hospital, Suwon, Korea.

ABSTRACT
We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

Show MeSH
Related in: MedlinePlus