Chronic Health Evaluation Scoring System Research Articles

Predictive factors for mortality in intensive care patients with Fournier's gangrene: five years' experience from a single center in Turkey.

The aim of this study was to analyze mortality-related factors and scoring systems in order to better manage the treatment process of patients monitored in the intensive care unit (ICU) due to Fournier's gangrene (FG). The study included 28 male patients who were monitored in the surgical ICU with the diagnosis of FG between December 2018 and August 2022. The patients' comorbidities, acute physiological and chronic health evaluation scoring system II (APACHE II), Fournier gangrene severity index (FGSI), sequential organ failure assessment (SOFA) scores, and laboratory data were evaluated retrospectively. Of the patients, 67.9% (n=19) had diabetes mellitus, 78.6% (n=22) had hypertension, and 71.4% (n=20) had coronary artery disease. The mortality rate was 42% (n=11). There was no statistically significant difference between the patients who died and those who survived in terms of the SOFA score, comorbidities, and albumin, glucose, and procalcitonin values (p > 0.05), but age, APACHE II and FGSI scores, and the C-reactive protein (CRP) value were significantly higher in the non-survivor group. There was a positive correlation between the FGSI, APACHE II, and SOFA scores. Older age, high CRP levels at the time of admission, and the presence of comorbidity are still determining factors in the prediction of mortality in patients with FG. We also determined that in predicting mortality in patients monitored in the ICU with the diagnosis of FG, in addition to the routinely used FGSI, the APACHE II score was also useful, but the SOFA score did not have significant predictive value.

Establishment of risk nomogram prediction model for venous catheter thrombosis.

Venous catheters are widely used in clinical practice, but a drawback of their usage is the increased risk of thrombosis. The current study explored the risk factors affecting the formation of thrombosis following venous catheterization and establishes a risk nomogram prediction model for catheter-related thrombosis. Univariate and multivariate logistic regression analyses were carried out to identify the independent factors involved in venous catheter thrombosis. These factors were included in the construction of a nomogram. Finally, the C-index and calibration curves were used to validate the nomogram. A total of 146 cases were included in the sample, of which 36 were cases of thrombosis. The results of the univariate logistic regression analysis showed that the following were significant factors: age, Acute Physiology and Chronic Health Evaluation scoring system (APACHE II) score, white blood cell (WBC), hematocrit (HCT), international normalized ratio (INR), fibrinogen (FIB), and D-dimer. Multivariate logistic regression analysis was performed, which confirmed that the factors of age (AUC: 0.677, 95% CI: 0.564-0.790), APACHE II score (AUC: 0.746, 95% CI: 0.656-0.837), INR (AUC: 0.743, 95% CI: 0.636-0.849), and D-dimer (AUC: 0.826, 95% CI: 0.750-0.902) were independent variables. Next, a nomogram was constructed using these independent variables for predicting venous catheter thrombosis. Favorable results with C-indexes (0.816; 95% CI: 0.780-0.882) and calibration curves closer to ideal curves indicated the accurate predictive ability of this nomogram. The individualized nomogram demonstrated effective prognostic prediction for patients with venous thrombosis.

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal.

Background and aimThe number of elderly patients with biliary stones is increasing. Endoscopic retrograde cholangiography (ERCP) is considered to be an effective treatment for biliary stones. Having a sound knowledge of the risk factors can help reduce the incidence and severity of complications for ERCP. Furthermore, limited research has been published on patients aged over 85 years undergoing endoscopic biliary stone removal. This study aims to determine the risk factors that lead to complications of ERCP in patients over 85 years of age.MethodsThis was a single-center retrospective study. We analyzed 156 patients aged ≥ 85 years with biliary stones who underwent their first ERCP at Chinese PLA General Hospital from February 2002 to March 2021. Logistic regression models were employed to identify the independent risk factors for complications.ResultsA total of 13 patients (8.3%) had complications. Thereinto, pancreatitis, cholangitis, bleeding, and other complications occurred in 4 cases (2.6%), 1 cases (0.6%), 4 cases (2.6%), and 4 cases (2.6%), respectively. There was no perforation or death related to ERCP. Independent risk factors for complications were acute biliary pancreatitis (ABP) (P = 0.017) and Charlson Comorbidity Index (CCI) (P = 0.019). Significantly, reasons for incomplete stone removal at once were large stone (>10 mm) (P < 0.001) and higher acute physiology and chronic health evaluation scoring system (APACHE-II) (P = 0.005).ConclusionsERCP was recommended with caution in patients ≥ 85 years of age with ABP or higher CCI undergoing endoscopic biliary stone removal. In patients with ABP without cholangitis or biliary obstruction we recommend against urgent (within 48 h) ERCP. Patients with higher CCI who can tolerate ERCP can undergo rapid ERCP biliary stenting or nasobiliary implantation with later treatment of stones, and patients who cannot tolerate ERCP are treated promptly with PTCD and aggressive conservative treatment.

Clinical Efficacy of Budesonide/Glycopyrronium Bromide/Formoterol in the Treatment of Patients with Acute Respiratory Distress Syndrome and Its Effect on Inflammatory Factors.

Objective To examine the clinical efficacy of budesonide/glycopyrronium bromide/formoterol (Breztri Aerosphere) as an adjunct to acute respiratory distress syndrome (ARDS). Methods A prospective study enrolled 120 patients with pulmonary endogenous ARDS admitted to the Department of Critical Care Medicine at the Fourth Hospital of Baotou from January 2017 to January 2020, and all enrollments were assigned (1 : 1) to receive conventional treatment (control group) or Breztri Aerosphere (study group). Results Breztri Aerosphere was associated with a significantly higher total efficacy versus conventional treatment. Breztri Aerosphere resulted in significantly lower acute physiology and chronic health evaluation scoring system (APACHE II) scores and Murray lung injury scores versus conventional treatment. Both groups saw an increase in the partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), and oxygen saturation (SaO2) after treatment, with higher levels seen in patients given Breztri Aerosphere. After treatment, systemic vascular resistance (SVR) in both groups rose markedly, with greater elevation witnessed in the study group. The patients given Breztri Aerosphere showed significantly lower levels of pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (MAPA), pulmonary artery wedge pressure (PAWP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and procalcitonin (PCT) versus those receiving conventional treatment. The patients experienced shorter mechanical ventilation time and intensive care unit (ICU) time after treatment of Breztri Aerosphere versus conventional treatment. Conclusion Adjuvant therapy with Breztri Aerosphere in ARDS can significantly lower APACHE II scores and Murray lung injury scores, improve blood gas indexes and pulmonary circulation function indexes, and shorten mechanical ventilation time and ICU time, which may be attributed to its improvement of organism inflammation status and reduction of inflammatory factors.

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia.

ObjectiveTo explore the etiology and diagnosis and treatment strategy of traumatic brain injury complicated with hyponatremia.Methods90 patients with traumatic brain injury admitted to our hospital from December 2019 to December 2020 were retrospectively analyzed and divided into hyponatremic group (50 patients) and non-hyponatremic group (40 patients) according to the patients' concomitant hyponatremia, and the clinical data of the two groups were collected and compared. In addition, patients in the hyponatremia group were divided into a control group and an experimental group of 25 patients each according to their order of admission, with the control group receiving conventional treatment and the experimental group using continuous renal replacement therapy (CRRT). Hemodynamic indices, mortality and serum neuron-specific enolase (NSE) indices before and after treatment were compared between the control and experimental groups. The Glasgow coma scale (GCS) was used to assess the degree of coma before and after the treatment in the two groups, and the patients' disease status was assessed using the Acute Physiological and Chronic Health Evaluation Scoring System (APACHE II).ResultsThe etiology of traumatic brain injury complicated with hyponatremia is related to the degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture (P < 0.05). After the treatment, the hemodynamic indexes, APACHE II scores, death rate, and NSE levels of the experimental group were significantly lower than those of the control group (P < 0.001); The experimental group yielded remarkably higher GAC scores as compared to the control group (P < 0.001).ConclusionThe degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture were considered to be the main factors for traumatic brain injury complicated with hyponatremia. Continuous renal replacement therapy can effectively improve the clinical indicators of the patients with a promising curative effect, which merits promotion and application.

Risk factors of carbapenem resistant Acinetobacter baumannii infection in intensive care unit

Objective: This study will analyze the clinical characteristics and risk factors that may be related to the 30-day mortality of patients infected with CRAB in intensive care unit (ICU), and explore the resistance of CRAB and its influence on mortality. Methods: From December 2012 to February 2021, 173 ICU patients with CRAB infection in the Fifth Medical Center of PLA General Hospital were selected as the research objects, and the relevant data were collected for retrospective analysis. There were 119 cases (68.8%) in survival group and 54 cases (31.2%) in the non-survival group. Patients with CRAB infection were (52.9±13.5) years old, including 140 males (80.9%) and 33 females (19.1%).The first detected CRAB was collected, and antibiotic sensitivity test was conducted after the strain was resuscitated to analyze the antibiotic resistance. Univariate and multivariate Cox models were used to analyze independent risk factors associated with 30-day mortality in patients with CRAB infection. Results: Univariate and multivariate Cox analysis showed that acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ)(HR=1.058, 95%CI:1.012-1.106, P=0.013) and septic shock (HR=6.240, 95%CI:2.227-17.483, P<0.001) were independent risk factors related to 30-day mortality in ICU patients with CRAB. Treatment with β-lactamase inhibitor (HR=0.496, 95%CI: 0.275-0.893, P<0.019) can reduce the 30-day mortality of patients with CRAB infection in ICU. The resistance rate of CRAB to cephalosporins, carbapenems, aminoglycosides and quinolones were more than 80%. The survival rate of patients infected by aminoglycoside resistant CRAB is low(χ²=4.012,P<0.05). Conclusion: The APACHE Ⅱ score, septic shock and use of β-lactamase inhibitors were independent factors associated with the 30-day mortality in ICU patients with CRAB infection.

Safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography for patients over 90 years of age

This study aimed to explore the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in patients over 90 years of age. The study included 176 patients aged over 85 years who received their ERCP from February 2002 to January 2021. In the case group (super-elderly group), 44 patients were 90 years old or above. In the control group (younger group), there were 132 patients aged 85-89 years. The control group was matched according to patient gender and the same indications of ERCP at a 1:3 ratio. Logistic regression models were employed to evaluate all complications. The case group had higher acute physiology and chronic health evaluation scoring system (APACHE-II) scores and rate of hypoalbuminemia. APACHE-II scores (≥6 or 7) were significantly more common in the case group. The rates of technical success and complete success in the case group were 100% and 100% respectively, which were similar to the rates in the control group, namely a technical success rate of 98.5% and a complete success rate of 98.5%. The rate of complication in the case group was 9.1%, which was slightly lower than that of the control group (15.2%, P > 0.05). ERCP-related death occurred in one patient in the control group, who had malignant biliary obstruction and died from cholangitis. There was no significant difference in the incidence of complications such as pancreatitis, hemorrhage, and infection between the two groups. In the multivariate analysis, the independent risk factor was Charlson Comorbidity Index (CCI) for overall complication. ERCP can be performed safely and successfully in patients aged ≥90 years. Geriatr Gerontol Int 2022; 22: 50-55.

Effect of electroacupuncture at Zusanli (ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis

To observe the effect of electroacupuncture (EA) of Zusanli(ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis (SAP). A total of 68 SAP patients (hospitalized from January of 2018 to December of 2019 in Cangzhou Hospital of Integrated Medicine) were randomly divided into control and EA groups (n=34 cases in each group). All patients of the two groups received the same early enteral nutrition treatment through nasojejunal tube. EA (5-15 Hz, 1-5 mA) was applied to bilateral ST36 and CV12 for 20 min, twice a day for 7 days. The incidence of feeding intolerance (abdominal distension, vomiting, diarrhea, constipation, gastrointestinal bleeding), time to reach energy target, intraperitoneal pressure and the number of borborygmus in 1 min were recorded. The contents of plasma high sensitivity -C reactive protein (hs-CRP), IL-6 and endotoxin were measured using Latex immunoturbidimetric method, chemiluminescence and Tachypiens Amebocyte Lysate Azo substrate color development method, respectively, and the contents of urinary lactulose and mannitol detected using high-performance liquid chromatography. The total protein and albumin levels in the blood were measured for assessing the patients' nutrition status, and acute physiology and chronic health evaluation scoring system (APACHE-Ⅱ) score was determined for assessing the severity of disease. Compared with the control group, the incidence of abdominal distension, vomiting and constipation, intolerance rate to feeding, time to reach the energy target, intraperitoneal pressure on day 7, inflammatory indexes, hs-CRP, IL-6, endotoxin, urine L/M on day 4 and 7, and the APACHE Ⅱ score on day 7 were significantly lower (P<0.01), and the number of borborygmus in 1 min on day 4 and 7 after the treatment was significantly higher in the EA group (P<0.01). In comparison with pretreatment, the abdominal pressure and plasma endotoxin level on day 4 and 7, hs-CRP, IL-6 and L/M ratio on day 1, 4 and 7, as well as APACHE Ⅱ score on day 7 after the treatment were significantly decreased in the two groups (P<0.01), and the number of borborygmus on day 4 and 7, and the total protein and albumin on day 7 significantly increased in both the control and EA groups (P<0.01). EA of ST36 and CV12 can shorten the time to reach the energy target, reduce inflammatory response, improve the intestinal mucosal barrier function, and thus reduce the incidence of feeding intolerance in SAP patients.

Status quo and influencing factors of stress hyperglycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection

Objective To analyze the influencing factors of stress hyperglycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection and to explore the methods of its monitoring and management. Methods Totally 100 patients with non-diabetic Standard Type A aortic dissection admitted in the Department of Cardiac Surgery, Zhongshan Hospital were retrospectively included. Their general information including age, gender, body mass index (BMI) , pain score, operation time and time of circulatory arrest as well as morning fasting blood-glucose (FBG) before operation, before extracorporeal circulation, before and after circulatory arrest, after rewarming, after machine halt, at ICU admission and on 1 - 6 day postoperatively was collected. Univariate analysis and Logistic regression analysis were used to explore the factors affecting the peak blood-glucose perioperatively. Results The area under the ROC curve for perioperative blood-glucose and overall adverse outcome was 0.646 (95%CI 0.528-0.763, P=0.021) , and the comparatively good cutoff value of perioperative peak blood-glucose for the disease was 14.35. The patients' blood-glucose started to rise after extracorporeal circulation, and the tendency to rise was more significant after rewarming. Their blood-glucose remained at a relatively high level at ICU admission. It tended to decrease since 24 h postoperatively, and it returned to normal levels at 6 d post operation. Univariate analysis showed that there was statistical difference in BMI, white blood cell, C-reactive protein (CRP) , time of extracorporeal circulation, Acute Physiology and Chronic Health Evaluation Scoring System (APACHEⅡ) and whether emergency surgery received between the patients with ≥14.35 mmol/L or 1) . Conclusions Severe inflammatory response and high BMI preoperatively indicate that stress hyperglycemia may occur in patients undergoing surgery for non-diabetic Standard Type A aortic dissection during the perioperative period. Perioperative hyperglycemia can be reduced by reducing the time of extracorporeal circulation. Medical and nursing workers need to enhance glycemic monitoring in the process of extracorporeal circulation, after rewarming and post operation and develop targeted glycemic management protocols for the patients. Key words: Aortic disease; Extracorporeal circulation; Perioperative period; Stanford Type A aortic dissection; Stress hyperglycemia

Development and application of dynamic scoring information system for critically ill patients

Objective To develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947 (95%CI 0.930-0.964) , which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P<0.05) . After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002) . Conclusions The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability. Key words: Critical illness; Scoring system; Informatization; Clinical decision-making; Alarm

Therapeutic effect of Bifidobacterium combined with early enteral nutrition in the treatment of severe acute pancreatitis: a pilot study.

To explore the therapeutic effect of Bifidobacterium combined with early enteral nutrition in severe acute pancreatitis. A total of 60 patients with severe acute pancreatitis admitted from November 2012 to November 2016 were retrospectively analyzed. According to the different treatment methods, the patients were divided into Bifidobacterium combined with early enteral nutrition group (experiment group) and early enteral nutrition group (control group). Serum ALB (albumin), CRP (C-reactive protein), WBC (white blood cell count) and PCT (procalcitonin) levels in both groups were observed. The pain relief time, diet recovery time, length of stay, and hospitalization costs between the two groups, were compared. The APACHE (acute physiology and chronic health evaluation scoring system) II score and SOFA (sequential organ failure assessment) score before and after nutritional support were compared between the two groups. Adverse events and complications were observed as well. 58 patients recovered and 2 died after treatment. Improvements in laboratory indicators such as ALB, CRP, WBC and PCT were much better in the experiment group than the control group (p<0.05). Both the length of days and hospitalization cost were lower in the experiment group than those of the control group (p=0.0029, p=0.0435). In the comparison of hospitalization symptoms, shorter pain relief time and diet recovery time were found in the experiment group than those in the control group (p=0.0003, p=0.0218). After the treatment, APACHE II score and SOFA score of the experiment group were also higher than the control group. No significant differences in adverse events and complications between the two groups were exerted (p>0.05). Bifidobacterium combined with early enteral nutrition can improve the nutritional status of patients with severe acute pancreatitis in the acute stage, which also enhances the patient's immune capacity and the body's resistance to disease.

Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis

Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis. The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score II (SAPS II), acute physiology and chronic health evaluation scoring system II (APACHE II) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above. 110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS II score, APACHE II score of death group were increased, and 24 h LCR was decreased. SAPS II [area under the ROC curve (AUC) = 0.877, P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869, P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815, P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE II score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889, P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891, P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%). SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.

Assessment the prognosis of patients after cardiopulmonary resuscitation with bispectral index

Objective To study the value of bispectral index (BIS) in predicting the prognosis of patients after cardiopulmonary resuscitation (CPR).Methods Thirty-two coma patients 72 hours after CPR were enrolled for study with monitoring the changes of BIS,glasgow coma scale (GCS) and acute physiology and chronic health evaluation scoring system (APACHE Ⅱ),and subsequently the monitored data were documented and analyzed.The patients were divided into 2 groups:good prognosis group (n =7)and poor prognosis group (n =25),and comparisons of BIS,GCS and APACHE Ⅱ were made between two groups.The area under the curve (ROC,AUC) of BIS and the intercept point for assessing prognosis were calculated.Results The 30-day survival rate in this study was 31.25 ％.The positive correlation between the values of BIS and GCS were obvious (r =0.707,P =0.000).Comparison of BIS between two groups showed difference was statistically significance (P =0.000).The area under the ROC of BIS was 0.943.When BIS ≤ 60,the sensitivity of predicting poor prognosis of patients after CPR was 100％ ; the specificity was 88％.Conclusions BIS monitoring could be a high sensitive indicator of evaluating prognosis of patients after cardiopulmonary resuscitation. Key words: Bispectral index ; Cardiopulmonary resuscitation; Prognosis

Computer Protocol Facilitates Evidence-Based Care of Sepsis in the Surgical Intensive Care Unit

Care of sepsis has been the focus of intense research and guideline development for more than two decades. With ongoing success of computer protocol (CP) technology and with publication of Surviving Sepsis Campaign (SSC) guidelines, we undertook protocol development for management of sepsis of surgical intensive care unit patients in mid-2006. A sepsis protocol was developed and implemented in The Methodist Hospital (TMH) (Houston, TX) surgical intensive care unit (27 beds) together with a sepsis research database. We compare paper-protocol (PP) (2008) and CP (2009) performance and results of the SSC guideline performance improvement initiative (2005-2008). TMH surgical intensive care unit sepsis protocol was developed to implement best evidence and to standardize decision making among surgical intensivists, nurse practitioners, and resident physicians. The 2008 and 2009 sepsis protocol cohorts had very similar number of patients, age, % male gender, Acute Physiology and Chronic Health Evaluation scoring system II, and Sequential Organ Failure Assessment scores. The 2008 PP patients had greater baseline lactate concentration consistent with greater mortality rate. Antibiotic agents were administered to 2009 CP cohort patients sooner than 2008 PP cohort patients. Both cohorts received similar volume of intravenous fluid boluses. Comparing 6-hour resuscitation bundle compliance, the 2009 CP cohort was substantially greater than SSC eighth quarter and 2008 PP cohorts (79% vs. 31% vs. 29%), and mortality rate was much less when using the CP (14% vs. 31% vs. 24%). Our comprehensive sepsis protocol has enabled rapid and consistent implementation of evidence-based care, and, implemented as a bedside CP, contributed to decreased mortality rate for management of surgical sepsis.

Evaluation of the Modified Acute Physiology and Chronic Health Evaluation Scoring System for Prediction of Mortality in Patients Admitted to an Emergency Department

Objective To evaluate the ability of the Modified Acute Physiology and Chronic Health Evaluation (M-APACHE II) scoring system for the prediction of mortality in patients admitted to a tertiary emergency department in Iran. Methods During the study period, all patients aged &gt;12 years who had been admitted to the emergency department of a tertiary hospital in Tehran, Iran were enrolled in the study. Traumatic and poisoned patients and those who died immediately after arriving at the emergency room were excluded. Using the M-APACHE II, risk of mortality was calculated for each patient. Finally, expected and observed mortalities were compared and the accuracy of M-APACHE II for prediction of mortality was determined using receiver operating characteristics (ROC) analysis. Results During the study period, 389 cases including 236 males (60.7%) were enrolled into the study. The mean age of the patients was 60.6±19.4 years (range 14 to 98 years). 117 patients died (30%) while the M-APACHE II predicted 129 deaths. The greatest discrepancy between observed and expected deaths occurred at M-APACHE II scores ≥21. The constructed area under the ROC curve basng on predicted and observed death was 0.938 (95% confidence interval 0.915-0.961). Conclusion M-APACHE II is an accurate scoring system for predicting mortality in patients admitted to the emergency department. However, further studies are needed to confirm our findings.

Escalas para evaluar la mortalidad de pacientes con trauma y síndrome de insuficiencia respiratoria progresiva del adulto

To compare different scores and scales used to evaluate mortality in patients with trauma and adult respiratory distress syndrome (ARDS). The clinical charts of 80 adult patients, 70 men and 10 women, who were admitted during the period from January Ist, 1990, to December 31st, 1993, to the Hospital Guillermo Barroso C., Cruz Roja Mexicana in Mexico City with trauma and ARDS, were revised. The following data were evaluated: sex, age, injury-producing mechanisms, associated morbid conditions (shock, multiple blood transfusions, long bone fracture, pulmonary contusion and sepsis), ARDS diagnostic criteria, systemic failure, multiple organ failure, injury severity score. Acute Physiology and Chronic Health Evaluation Scoring System, time elapsed to ARDS diagnosis, period of tracheal intubation and stay at the intensive care unit. Of the 80 patients, 26 died (32.5%), 2 women and 24 men. Injury-producing mechanisms were: running over (31.3%), car accidents (27.5%), gunshot wounds (15%), stab wounds (13.7%) multiple contusions (7.5%) and falls (5%). A highly significant relationship was found between all scores and scales investigated and mortality. In pulmonary contusion and gastrointestinal failure correlation was doubtful; period of tracheal intubation and stay at the intensive care unit showed no correlation to mortality. Adult patients with trauma who develop ARDS showed high probability of death if additional clinical data of shock and consolidation in three or four quadrants of thorax X-rays are present, among other factors.

Verification of the Acute Physiology and Chronic Health Evaluation scoring system in a Hong Kong intensive care unit.

To validate the Acute Physiology and Chronic Health Evaluation (APACHE II) severity of illness scoring system in Chinese patients in a multidisciplinary intensive care unit (ICU) in Hong Kong. To audit the service and utilization of an ICU with a low ICU to hospital bed ratio. Prospective data collection and review. A 12-bed multidisciplinary ICU within a 1,430-bed tertiary care university hospital. Data from 1,573 of 1,814 consecutive patients admitted to the ICU from May 1988 to November 1990 were studied. The patients were all Chinese. None. The patients' clinical details and APACHE II scores were recorded on day 2 of admission and reviewed at hospital discharge or after death. The APACHE II scores, risk of death values, age, and length of ICU stay between survivors and nonsurvivors were compared by two-sample t-tests. Relationships between mortality and APACHE II score, risk of death, and results from previous studies were investigated using the Pearson product-moment coefficient and regression analysis. Predictive capacity of risk of death was assessed by receiver operating characteristic curve analysis. The hospital mortality rate for study patients was 36%. Survivors were younger, had shorter ICU stays, lower APACHE scores, and lower risk of death values than nonsurvivors (p < .001). There was close correlation (r2 = .81, .77, and .76 for all patients, operative group, nonoperative group, respectively) between APACHE II scores and predicted risk of death values. Risk of death was an accurate group predictor of death in all patients and in separate operative and nonoperative groups. Areas under the receiver operating characteristic curves were 0.89 (all patients), 0.85 (operative), and 0.88 (nonoperative). Neither the Apache II scores nor risk of death scores were sufficiently accurate to predict outcome of individual patients. There was close concordance between observed and predicted mortality of patient groups. Mortality ratio was 0.97 (all patients), 0.89 (operative group), and 1.02 (nonoperative group). Chronological age, per se, was not a good predictor of mortality. The audit of the ICU service showed a short length (4.2 days) of ICU stay and high bed occupancy (80%). Subgroups of low-risk, postoperative patients with good outcomes and poor-risk patients admitted after cardiopulmonary arrest with a high mortality rate were identified. The APACHE II scoring system was an accurate predictor of group outcome in a Chinese population, making it suitable for comparisons between countries. Application of the APACHE II scoring system in a clinical audit facilitates critical appraisal of an ICU service. Problems identified by the study were a shortage of ICU beds and delayed referrals of patients.