Assessment of Prediction of Mortality by Using the APACHE II Scoring System in Intensive-Care Units

H. MICHAEL MARSH, IQBAL KRISHAN, JAMES M. NAESSENS, ROBERT A. STRICKLAND, DOUGLAS R. GRACEY, MARY E. CAMPION, FRED T. NOBREGA, PETER A. SOUTHORN, JOHN C. McMICHAN, MARY P. KELLY

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40 Scopus citations

Abstract

Some investigators have suggested that information on quality of care in intensive-care units (ICUs) may be inferred from mortality rates. Specifically, the ratio of actual to predicted hospital mortality (A/P) has been proposed as a valid measure for comparing ICU outcomes when predicted mortality has been derived from data collected during the first 24 hours of ICU therapy with use of a severity scoring tool, APACHE II (acute physiology and chronic health evaluation). We present a comparison of mortality ratios (A/P) in four ICUs under common management, in two hospitals within a single institution. Significant differences in A/P were detected for nonoperative patients (0.99 versus 0.67; P = 0.014) between the two hospitals. This variation was traced to uneven representation of a subset of patients who had chronic health problems related to diseases that necessitated admission to the hematology-oncology or hepatology service. No differences in A/P were seen between the two hospitals for operative patients or for nonoperative patients on services other than hematology-oncology or hepatology. Thus, differences in A/P detected by using the APACHE II system not only may reside in operational factors within the ICU organization but also may be related to weaknesses in the APACHE II model to measure factors intrinsic to the disease process in some patients. We suggest that case-mix must be examined in detail before concluding that differences in A/P are caused by differences in quality of care.

Original languageEnglish (US)
Pages (from-to)1549-1557
Number of pages9
JournalMayo Clinic proceedings
Volume65
Issue number12
DOIs
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Medicine(all)

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    MARSH, H. MICHAEL., KRISHAN, IQBAL., NAESSENS, JAMES. M., STRICKLAND, ROBERT. A., GRACEY, DOUGLAS. R., CAMPION, MARY. E., NOBREGA, FRED. T., SOUTHORN, PETER. A., McMICHAN, JOHN. C., & KELLY, MARY. P. (1990). Assessment of Prediction of Mortality by Using the APACHE II Scoring System in Intensive-Care Units. Mayo Clinic proceedings, 65(12), 1549-1557. https://doi.org/10.1016/S0025-6196(12)62188-0