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  1. Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness.

    Article - En anglais

    Objetive : To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness.

    Design 

    Prospective cohort study.

    Setting 

    Surgical intensive care unit of an urban, tertiary-care university hospital.

    Participants 

    Eight hundred forty-four consecutive patients in the surgical intensive care unit.

    Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups.

    Main Outcome Measures 

    Survival to hospital discharge, and survival compared with published normative APACHE II and III databases.

    Results 

    Mean age was 65.1±0.5 years.

    Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital.

    The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P<. 0001) (range of correlation coefficients, 72 to. 86) overall and in all subgroups.

    Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P<. 01) higher overall and in all subgroups.

    Conclusions 

    In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective.

    However, the differences are subtle and may be difficult to detect in smaller studies.

    Mots-clés Pascal : Pronostic, Malade, Chronique, Postopératoire, Chirurgie, Mortalité, Test score, Unité soin intensif, Etude comparative, Etude cohorte, Etude statistique, Homme

    Mots-clés Pascal anglais : Prognosis, Patient, Chronic, Postoperative, Surgery, Mortality, Score test, Intensive care unit, Comparative study, Cohort study, Statistical study, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0264601

    Code Inist : 002B30A01C. Création : 01/03/1996.