Severity and prognosis in intensive care: prospective application of the APACHE II index.
BACKGROUND
The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature.


OBJECTIVE
To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates.


METHODS
Prospective study of patients' outcomes.


METHODS
A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina).


METHODS
520 patients selected according to sex, age and nature of hospitalization.


METHODS
The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery.


METHODS
The APACHE II index.


RESULTS
The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28. 5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one.


CONCLUSIONS
The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.
Costa
J I
JI
Discipline of Anesthesiology, Pain and Intensive Care, Universidade Federal São Paulo/Escola Paulista de Medicina, São Paulo, Brazil.
Gomes do Amaral
J L
JL
Munechika
M
M
Juliano
Y
Y
Bezerra Filho
J G
JG
D018806:APACHE; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index