PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jrsocmedLink to Publisher's site
 
J R Soc Med. 1994 February; 87(2): 73–77.
PMCID: PMC1294319

APACHE II scoring system on a general intensive care unit: audit of daily APACHE II scores and 6-month survival of 691 patients admitted to a general intensive care unit between May 1990 and December 1991.

Abstract

In this paper we present a detailed analysis of the use of the APACHE II (acute physiological and chronic health evaluation) scoring system on all of the patients admitted to the general intensive care unit at the Bristol Royal Infirmary over a 20-month period. The 6-month survival of 691 adult medical and surgical patients following intensive care was recorded and this data was analysed with admission and daily APACHE II scores using a relational database. Our data confirms the relationship between admission APACHE II scores and outcome, with mean scores decreasing as duration of survival increases. We also demonstrate that the best day one scores are approximately 50% less than the admission score, irrespective of outcome, indicating the benefit of intensive care. By contrast, however, the scores on day one have either not improved or have worsened since admission, reflecting the importance of the pre-morbid health status of the patient in determining outcome from intensive care.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370–378. [PubMed]
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. [PubMed]
  • Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981 Aug;9(8):591–597. [PubMed]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed]
  • Wagner D, Draper E, Knaus W. APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Development of APACHE III. Crit Care Med. 1989 Dec;17(12 Pt 2):S199–S203. [PubMed]
  • Chang RW, Jacobs S, Lee B. Predicting outcome among intensive care unit patients using computerised trend analysis of daily Apache II scores corrected for organ system failure. Intensive Care Med. 1988;14(5):558–566. [PubMed]
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in acute organ-system failure. Ann Surg. 1985 Dec;202(6):685–693. [PubMed]
  • Dragsted L, Qvist J, Madsen M. Outcome from intensive care. II. A 5-year study of 1308 patients: short-term outcome. Eur J Anaesthesiol. 1989 Mar;6(2):131–144. [PubMed]
  • Zarén B, Bergström R. Survival compared to the general population and changes in health status among intensive care patients. Acta Anaesthesiol Scand. 1989 Jan;33(1):6–12. [PubMed]
  • Ridley S, Jackson R, Findlay J, Wallace P. Long term survival after intensive care. BMJ. 1990 Nov 17;301(6761):1127–1130. [PMC free article] [PubMed]
  • Jacobs CJ, van der Vliet JA, van Roozendaal MT, van der Linden CJ. Mortality and quality of life after intensive care for critical illness. Intensive Care Med. 1988;14(3):217–220. [PubMed]
  • Knaus WA, Le Gall JR, Wagner DP, Draper EA, Loirat P, Campos RA, Cullen DJ, Kohles MK, Glaser P, Granthil C, et al. A comparison of intensive care in the U.S.A. and France. Lancet. 1982 Sep 18;2(8299):642–646. [PubMed]
  • Meakins JL. Surgeons, surgery and pancreatitis. Gastroenterol Clin Biol. 1984 Jun-Jul;8(6-7):531–532. [PubMed]
  • Jacobs S, Chang RW, Lee B, Lee B. Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system. Intensive Care Med. 1988;14(5):567–574. [PubMed]
  • Lemeshow S, Teres D, Pastides H, Avrunin JS, Steingrub JS. A method for predicting survival and mortality of ICU patients using objectively derived weights. Crit Care Med. 1985 Jul;13(7):519–525. [PubMed]
  • Lemeshow S, Teres D, Avrunin JS, Gage RW. Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med. 1988 May;16(5):470–477. [PubMed]
  • Potgieter PD, Rosenthal E, Benatar SR. Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med. 1985 Oct;13(10):798–802. [PubMed]
  • Jacobs S, Chang RW, Lee B. One year's experience with the APACHE II severity of disease classification system in a general intensive care unit. Anaesthesia. 1987 Jul;42(7):738–744. [PubMed]
  • Chang RW, Jacobs S, Lee B, Pace N. Predicting deaths among intensive care unit patients. Crit Care Med. 1988 Jan;16(1):34–42. [PubMed]
  • Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988 Dec;94(6):1176–1186. [PubMed]
  • Wagner DP, Knaus WA, Draper EA. Statistical validation of a severity of illness measure. Am J Public Health. 1983 Aug;73(8):878–884. [PubMed]
  • Chang RW. Individual outcome prediction models for intensive care units. Lancet. 1989 Jul 15;2(8655):143–146. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press