Introduction:
The aim of this study was to assess the Acute Physiology and Chronic Health
Evaluation (APACHE II) prognostic index in the Intensive Care Unit of Kimberley
Hospital Complex (KHC) on admission. The study was more specifically aimed at
patients meeting criteria for the Systemic Inflammatory Response Syndrome (SIRS),
as patients admitted to KHC ICU frequently meet the criteria and often progress to
sepsis, severe sepsis and septic shock.
Design:
A cohort study on South African patients meeting SIRS criteria, including all races
and gender.
Setting:
Intensive Care Unit of Kimberley Hospital Complex, provincial hospital in the
Northern Cape province, South Africa.
Patients and measurements:
Consecutive patients meeting the criteria for SIRS on admission to ICU between
August 2006 and May 2007 were included. For each patient the diagnosis,
physiological and chronic health data necessary for the APACHE score was gathered
and recorded by the doctor on duty on time of admission.
Predicted and actual mortality rates were calculated. Data was provided to the
department of Biostatistics of the UFS for processing. Results were summarised by
means, standard variations and percentiles (numerical variables) and frequencies and
percentages (categorical variables).
Results
Of the 160 patients included in the study, 59 died (36.9%). Patients discharged from
the unit before 14 days were followed up in the ward until 14 days or discharge from
hospital (whichever came first). 77 patients were discharged from ICU within 14
days of which 3 (1.9%) died in the ward within the 14-day period. 74 of the
discharged patients (46.3%) were alive after 14 days. 24 patients (14%) participating
in the trial were still in ICU after 14 days and mortality not recorded.
The counting of patients who survived and those who died, for each level of death
risk predicted, allowed the calculation of sensitivity, specificity and the percentage of correct predictions for each level of predicted death risk.
The sensitivity of the calculated death risk was higher at scores below 8, gradually
decreasing as scores increased, reaching 50.9% at score >21. Conversely the
specificity increased from 1% for scores <5, reaching 79.2% for death risk at scores
>21. The most accurate combination of sensitivity and specificity was found at
scores of 16-18, with the positive prediction value ranging from 51.3-54.4% and the
negative prediction value ranging from 76.1-77.5%.
There was a meaningful connection between APACHE II scores and the mortality
rate, for all patients and each diagnostic group. In each successive APACHE II score
interval the mortality rate was higher than that of the preceding interval. Thus, the
result has confirmed the capability of this index to stratify such patients according to
the degree of severity of their health condition.
Conclusion
The APACHE II scoring system may be usefully applied in Intensive Care Units for
predicting mortality, classifying and assessing severity of disease and evaluating
performance. It must however be used with caution for planning department resource
allocation and decision making regarding admission of patients to Intensive Care.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufs/oai:etd.uovs.ac.za:etd-03112010-092725 |
| Date | 11 March 2010 |
| Creators | Krog, Colleen |
| Contributors | Dr PS van der Berg |
| Publisher | University of the Free State |
| Source Sets | South African National ETD Portal |
| Language | en-uk |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.uovs.ac.za//theses/available/etd-03112010-092725/restricted/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University Free State or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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