J Korean Med Sci.  2009 Jun;24(3):420-426. 10.3346/jkms.2009.24.3.420.

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

• KMID: 1779157
• DOI: http://doi.org/10.3346/jkms.2009.24.3.420

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.

Keyword

APACHE; Intensive Care Units; Mortality; Simplified Acute Physiologic Score; Subarachnoid Hemorrhage; Brain Injuries

MeSH Terms

*APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Area Under Curve
Brain Injuries/diagnosis/*mortality/surgery
Child, Preschool
Female
*Hospital Mortality
Humans
*Intensive Care Units
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
ROC Curve
Retrospective Studies
Severity of Illness Index
Subarachnoid Hemorrhage/diagnosis/*mortality/surgery
Time Factors

Figure

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  Fig. 1 Grouped distributions of predicted risk of hospital death for APACHE II and SAPS II scores

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  Fig. 2 Comparison of the calibration curves for APACHE II and SAPS II scores for hospital mortality prediction.

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  Fig. 3 Discriminative ability of clinical prediction rules (outcome=death) derived from APACHE II and SAPS II scoring systems

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