Evaluation of the Acute Physiology and Chronic Health Evaluation III in predicting the prognosis of patients admitted to Emergency Department, in need of intensive care unit.
BACKGROUND
Many of critically ill patients receive medical care for prolonged periods in emergency department (ED). This study is the evaluation of efficiency of Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in predicting mortality rate in these patients.


METHODS
This study was conducted between 2008 and 2009 in Tehran, Iran. One hundred subjects were enrolled in the study. Cases were chosen from patients in need of intensive care unit (ICU) bed who were kept in the ED. The APACHE III scores and predicted and observed mortality rates were calculated using the information from patients' files, interviews with the patients' families, and performing required physical examinations and laboratory tests.


RESULTS
The age of the patients and the ED length of stay were 66.07 (±19.92) years and 5.11 (±3.79) days, respectively. The mean (±SD) of APACHE III score of the patients was 58.89 (±18.24). The predicted mortality rate was calculated to be 32.73%, whereas the observed mortality rate was 55%. The mean (±SD) of APACHE III score of survivors and nonsurvivors was 48.63 (±16.35) and 67.63 (±14.84), respectively (P < .001). Furthermore, the ED length of stay was 3.20 (±1.34) and 6.57 (±4.4) days in survivors vs nonsurvivors, respectively (P < .001).


CONCLUSIONS
The APACHE III score and ED lengths of stay were higher in this study compared with other studies. This could be ascribed to more critical patients presenting to the study center and also limited ICU bed availability. This study was indicative of applicability of APACHE III scoring system in evaluating the quality of care and prognosis of ED patients in need of ICU.
Department of Emergency Medicine, Imam Hosain Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran.
Hamid Reza
HR
Hatamabadi
Parvin
P
Darbandsar Mazandarani
Ali
A
Abdalvand
Ali
A
Arhami Dolatabadi
Afshin
A
Amini
Hamid
H
Kariman
Hojjat
H
Derakhshanfar
D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007492:Iran; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis