title: Evaluation of the performance of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for critically ill patients in emergency departments in Hong Kong.
abstract: BACKGROUND
  Numerous prognostic predictive models have been developed for critically ill patients, many of which are primarily designed for use in intensive care units. The objective of this study was to evaluate the accuracy of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in predicting the mortality for critically ill patients managed in emergency department (ED) resuscitation rooms in Hong Kong.
  
  
  METHODS
  A multi-centre, prospective study was conducted for patients managed in the resuscitation rooms of the EDs of four major hospitals, including one university teaching hospital. The primary outcome measure was 14 day all-cause mortality and the secondary outcome measure was the length of stay in hospital.
  
  
  RESULTS
  Of 867 patients recruited between 4 and 30 April 2004, 106 (12.2%) patients died. The modified APACHE II score was found to be significantly higher in non-survivors compared to survivors (mean+/-S.D.: 21.2+/-7.7 versus 14.4+/-7.1, p<0.001). The area under the curve for modified APACHE II in predicting mortality was 0.743 (95% CI, 0.696-0.790).
  
  
  CONCLUSIONS
  The modified APACHE II score is only a moderate predictor of mortality for critically ill patients managed in the resuscitation rooms of EDs in Hong Kong. A more ED specific scoring method is required.
authors: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors: Shin Yan
authors: SY
authors: Man
authors: Ka Man
authors: KM
authors: Chan
authors: Fung Yi
authors: FY
authors: Wong
authors: Kit Yi
authors: KY
authors: Wong
authors: Chi Lap
authors: CL
authors: Yim
authors: Paulina S K
authors: PS
authors: Mak
authors: Chak Wah
authors: CW
authors: Kam
authors: Chor Chiu
authors: CC
authors: Lau
authors: Fei Lung
authors: FL
authors: Lau
authors: Colin A
authors: CA
authors: Graham
authors: Timothy H
authors: TH
authors: Rainer
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012151:Resuscitation / Q000706:statistics & numerical data*; D015996:Survival Rate