Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness
P. S. Barie, L. J. Hydo and E. Fischer
Department of Surgery, Cornell University Medical College, New York Hospital-Cornell Medical Center, NY.
OBJECTIVE: To determine whether the Acute Physiology and Chronic Health
Evaluation III (APACHE III), an updated version of APACHE II that contains
a larger number of postoperative patients in the normative database, offers
better prediction in critical surgical illness. DESIGN: Prospective cohort
study. SETTING: Surgical intensive care unit of an urban, tertiary-care
university hospital. PARTICIPANTS: Eight hundred forty-four consecutive
patients in the surgical intensive care unit. Overall scores were
determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma,
postoperative, and nonoperative patient subgroups. MAIN OUTCOME MEASURES:
Survival to hospital discharge, and survival compared with published
normative APACHE II and III databases. RESULTS: Mean age was 65.1 +/- 0.5
years. Overall mortality was 7.0% in the surgical intensive care unit and
9.1% in the hospital. The relationship between APACHE II and APACHE III
scores for individual patients was linear and correlated significantly (P
< .0001) (range of correlation coefficients, .72 to .86) overall and in
all subgroups. Both scoring systems overestimated our mortality, but
estimations made by APACHE III were significantly (P < .01) higher
overall and in all subgroups. CONCLUSIONS: In institutions or groups of
patients where APACHE II underestimates mortality, APACHE III may be
corrective. However, the differences are subtle and may be difficult to
detect in smaller studies.
