Porath A, Eldar N, Harman-Bohem I, Gurman G
Epidemiology Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Isr J Med Sci. 1994 Jul;30(7):514-20.
The objective of our study was to evaluate the applicability of the Acute Physiology and Chronic Health Evaluation (Apache II) scoring system in an Israeli general intensive care unit (GICU), and to monitor the outcome of care using the Apache II severity score. We compared over a 3-year period the distribution of Apache II score, and of hospital mortality in our GICU (790 consecutive admissions) to that of the original American study, using a prediction formula based on 5,815 admissions in the United States. Our admissions were classified as post-elective surgery, post-emergency surgery or nonsurgical. Patients' ages were 53 +/- 21 years. The mean APache II score was 13.3 +/- 7.8, and was significantly lower in the 612 survivors (11.1 +/- 6.7) than in the 178 nonsurvivors (19.2 +/- 8.4). The in-hospital mortality rate was higher, 22.5%, compared to the predicted 18.3% (odds ratio 1.14, 95% CI 1.01, 1.27). The majority of excess mortality occurred in the nonsurgical group (odds ratio 1.27, 95% CI 1.09, 1.48). We found the Apache II score useful for determining the severity of illness in our GICU. The Apache equation accurately predicts the mortality of elective and emergency surgery admissions, but underestimates the mortality of nonsurgical admissions.
我们研究的目的是评估急性生理学与慢性健康状况评价系统（APACHE II）评分系统在以色列综合重症监护病房（GICU）中的适用性，并使用APACHE II严重程度评分来监测护理结果。我们在3年的时间里，将我们GICU（790例连续入院患者）的APACHE II评分分布及医院死亡率，与美国一项基于5815例入院患者的原始研究结果进行比较。我们的入院患者分为择期手术后、急诊手术后或非手术患者。患者年龄为53±21岁。APACHE II评分的平均值为13.3±7.8，612名幸存者（11.1±6.7）的评分显著低于178名非幸存者（19.2±8.4）。与预测的18.3%相比，住院死亡率更高，为22.5%（优势比1.14，95%可信区间1.01，1.27）。大多数额外的死亡发生在非手术组（优势比1.27，95%可信区间1.09，1.48）。我们发现APACHE II评分有助于确定我们GICU中疾病的严重程度。APACHE公式能准确预测择期和急诊手术入院患者的死亡率，但低估了非手术入院患者的死亡率。
