title: Age influences the predictive value of Acute Physiology and Chronic Health Evaluation II and Intensive Care National Audit and Research Centre scoring models in patients admitted to Intensive Care Units after in-hospital cardiac arrest.
abstract: BACKGROUND
  Outcomes following in-hospital cardiac arrest (IHCA) are generally poor though different patient populations may benefit to different degrees from admission to Intensive Care Units (ICUs). Risk stratification algorithms may be useful in identifying patients who are most likely to benefit from ICU admission and so may aid allocation of this scarce resource. We aimed to compare the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Intensive Care National Audit and Research Centre (ICNARC) scoring systems in predicting outcome following ICU admission after IHCA in younger (≤69 years) and older (≥70 years) patients.
  
  
  METHODS
  We performed a retrospective observational study in two adult ICUs from January 2006 to February 2010 inclusive. Patients were divided into younger (≤69 years) and older (≥70 years) patients. The primary outcome measures were acute hospital mortality and area under the curve (AUC) calculation for receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  Two hundred and sixty-one adult consecutive adult patients admitted following IHCA. Hospital mortality was 58.6%. ROC analysis demonstrated that ICNARC was more accurate than APACHE II in predicting acute hospital outcomes in the adult population (AUC 0.734 vs. 0.706). Both scoring systems performed weaker when predicting outcomes in younger patients compared to older patients (ICNARC AUC 0.655 vs. 0.810; APACHE II AUC 0.660 vs. 0.759).
  
  
  CONCLUSIONS
  Both APACHE II and ICNARC predict outcome well in older patients. In younger patients, their value is less clear, and so they must be used with caution.
authors: Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
authors: D N S
authors: DN
authors: Senaratne
authors: Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK ; Department of Critical Care Medicine, University Hospital of Birmingham NHS Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
authors: T
authors: T
authors: Veenith
keywords: Acute Physiology and Chronic Health Evaluation II; Intensive Care National Audit and Research Centre; in-hospital cardiac arrest