Civetta J M, Hudson-Civetta J A, Nelson L D
Department of Surgery, University of Miami School of Medicine, Florida 33101.
Ann Surg. 1990 Sep;212(3):266-74; discussion 274-6. doi: 10.1097/00000658-199009000-00005.
APACHE II (an acronym formed from acute physiology score and chronic health evaluation) has been proposed to limit intensive care unit (ICU) admissions ('cost containment') and to judge outcome ('quality assurance') of surgical patients. To judge its performance, a 6-month study of 372 surgical ICU patients was performed. When patients were divided by mean duration of stay, mortality rates rose from 1% (short stay) to 19% (long stay) (p less than 0.001) for patients with APACHE II scores less than 10, but decreased from 94% (short stay) to 60% (long stay) (p less than 0.01) for patients with APACHE II scores more than 24. Exclusion of patients by high or low APACHE scores would 'save' 6% of ICU days but risk increasing morbidity, hospital costs, and deaths. Grouped APACHE II scores did not correlate with total hospital charges (r = 0.05, p = 0.89) or ICU days used (r = 0.42, p = 0.17). Grouping by APACHE II score and duration of ICU stay showed neither symmetry nor uniformity of mortality rates. Surgical patients would not be well served by APACHE II for quality assurance or cost containment.
急性生理与慢性健康状况评分系统II（APACHE II，由急性生理评分和慢性健康评估首字母缩写而成）已被提议用于限制重症监护病房（ICU）收治患者数量（“成本控制”）以及评判外科手术患者的预后（“质量保证”）。为评估其性能，对372例外科ICU患者进行了为期6个月的研究。当根据平均住院时间对患者进行分组时，APACHE II评分低于10分的患者，死亡率从1%（短期住院）升至19%（长期住院）（p<0.001），而APACHE II评分高于24分的患者，死亡率则从94%（短期住院）降至60%（长期住院）（p<0.01）。通过高或低APACHE评分排除患者将“节省”6%的ICU住院天数，但可能会增加发病率、医院成本和死亡风险。分组后的APACHE II评分与总住院费用（r = 0.05，p = 0.89）或ICU使用天数（r = 0.42，p = 0.17）均无相关性。按APACHE II评分和ICU住院时间分组显示，死亡率既不对称也不均匀。对于质量保证或成本控制而言，APACHE II对手术患者并无益处。
