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.
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.
Man
Shin Yan
SY
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China.
Chan
Ka Man
KM
Wong
Fung Yi
FY
Wong
Kit Yi
KY
Yim
Chi Lap
CL
Mak
Paulina S K
PS
Kam
Chak Wah
CW
Lau
Chor Chiu
CC
Lau
Fei Lung
FL
Graham
Colin A
CA
Rainer
Timothy H
TH
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