Skip to main content
NCBI home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 1988 Aug 1;14(5):567–574. doi: 10.1007/BF00263531

Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system

S Jacobs 1, R W S Chang 2, B Lee 1,2
PMCID: PMC7095262  PMID: 3221010

Abstract

608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. The mean Apache II scores for survivors (396) and non-survivors (187) were 13 (SD 7) and 24 (SD 9), and their Risk of Death were 16 (SD 16) and 47 (SD 27) respectively (p(0.001 for both). The majority of deaths (75%: 141/187) in our series came from those with chronic ill health (55%: 103/187), of whom 37% (38/103) were in endstage disease, and those with “old” trauma (18%: 34/187) often with incipient sepsis transferred from other hospitals after a mean delay of 9 days. Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.

Key words: Audit, Intensive care, Apache II system

References

  • 1.Jacobs S, Chang RWS, Lee B. One year's experience with the Apache II severity of disease classification system in a general Intensive Care Unit. Anaesthesia. 1987;42:738. doi: 10.1111/j.1365-2044.1987.tb05319.x. [DOI] [PubMed] [Google Scholar]
  • 2.Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Apache II: a severity of disease classification system. Crit Care Med. 1985;13:818. doi: 10.1097/00003246-198510000-00009. [DOI] [PubMed] [Google Scholar]
  • 3.Chang RWS, Jacobs S, Lee B. Use of Apache II severity of disease classification system to identify intensive care patients who would not benefit from total parenteral nutrition. Lancet. 1986;I:1483. doi: 10.1016/S0140-6736(86)91511-4. [DOI] [PubMed] [Google Scholar]
  • 4.Chang RWS, Jacobs S, Lee B, Pace N. Predicting deaths among ICU patients. Crit Care Med. 1988;16:34. doi: 10.1097/00003246-198801000-00007. [DOI] [PubMed] [Google Scholar]
  • 5.Civetta JM. Selection of patients for intensive care. In: Ledingham I McA., editor. Recent advances in intensive therapy. Edinburgh: Churchill Livingstone; 1977. p. 9. [Google Scholar]
  • 6.Shoemaker WC, Pierchala C, Chang PC, State D. Use of frequency distribution of cardio-respiratory variables to predict outcome and severity of illness in post-operative patients. Crit Care Med. 1977;5:82. doi: 10.1097/00003246-197703000-00004. [DOI] [PubMed] [Google Scholar]
  • 7.Baker SP, O'Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. Trauma. 1974;14:187. doi: 10.1097/00005373-197403000-00001. [DOI] [PubMed] [Google Scholar]
  • 8.Lemeshow S, Teres D, Pastides H, Avrunin JS, Steingrub JS. A method for predicting survival and mortality of ICU patients using objective derived weights. Crit Care Med. 1985;13:519. doi: 10.1097/00003246-198507000-00001. [DOI] [PubMed] [Google Scholar]
  • 9.Bland RD, Shoemaker WC. Probability of survival as a prognostic and severity of illness score in critically ill surgical patients. Crit Care Med. 1985;13:91. doi: 10.1097/00003246-198502000-00007. [DOI] [PubMed] [Google Scholar]
  • 10.Teres T, Lemeshow S, Avrunin JS, Pastides H. Validation of the mortality prediction model for ICU patients. Crit Care Med. 1987;15:208. doi: 10.1097/00003246-198703000-00005. [DOI] [PubMed] [Google Scholar]
  • 11.Le Gall J, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D. A simplified acute physiological score for ICU patients. Crit Care Med. 1984;12:975. doi: 10.1097/00003246-198411000-00012. [DOI] [PubMed] [Google Scholar]
  • 12.National Institute of Health Consensus Development Conference Critical care medicine. JAMA. 1983;250:798. doi: 10.1001/jama.1983.03340060076034. [DOI] [PubMed] [Google Scholar]
  • 13.Bion JF, Edlin SA, Ramsay G, McCabe S, Ledingham Im. Validation of a prognostic score in critically ill patients undergoing transport. Br Med J. 1985;291:432. doi: 10.1136/bmj.291.6493.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in acute organ-system failure. Ann Surg. 1985;202:685. doi: 10.1097/00000658-198512000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Garden OJ, Motyl H, Gilmour WH, Utley RJ, Carter DC. Prediction of outcome following acute variceal haemorrhage. Br J Surg. 1985;72:91. doi: 10.1002/bjs.1800720205. [DOI] [PubMed] [Google Scholar]
  • 16.Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centres. Ann Intern Med. 1986;104:410. doi: 10.7326/0003-4819-104-3-410. [DOI] [PubMed] [Google Scholar]

Articles from Intensive Care Medicine are provided here courtesy of Nature Publishing Group

RESOURCES