Evaluating APACHE II and APACHE IV Scoring Systems in Predicting Mortality Rate and Length of Hospital Stay in Patients with Head Trauma

Abstract

Background: A series of criteria are developed to assess the patients' severity of illness in ICU. APACHE is a wieldy used criterion. Objectives: The current study aimed to determine the difference between APACHE II and APACHE IV scoring systems in predicting mortality rate and length of hospital stay in patients with head trauma referred to Poursina Hospital in the Rasht.Methods: In this retrospective analytical study, medical records of patients hospitalized due to head trauma in the ICU of Poursina Hospital from February 25, 2009, to August 21, 2019, are investigated. Results:Of 1472 ICU patients,(39.3%) were died. The predicted mortality rate by the APACHE II scoring system before and after surgery was 28.7% and 12.8%, respectively. While APACHE IV could predict 39% of death. The mean hospitalization duration of patients was 15±41.35 days. Also, the mean ICU hospitalization was 9.77±9.24 days. While the mean estimated length of stay based on APACHE IV was 6.23 67±.8 days. The APACHE IV underestimated the length of stay (p<0.001). According to the ROC chart, the best cut-off for APACHE IV was 66, with a sensitivity of 85.8% and specificity of 85.4%. For APACHE II, the best cut off score was 20 with a sensitivity of 86.4% and specificity of 81.3%.Conclusion: Both APACHE II and APACHE IV tools can be used to predict the mortality of ICU patients, but APACHE IV is more effective and accurate. Considering that APACHE II and IV tools are developed based on Western culture, these tools should be localized based on geographical and climatic conditions.