Comparative study of scoring systems in ICU and emergency department in predicting mortality of critically ill
DOI:
https://doi.org/10.18203/2320-6012.ijrms20171225Keywords:
APACHE, MEWS, Mortality outcome, REMS, SAPSAbstract
Background: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, and guide the allocation of resources and to estimate the quality of care. It remains unclear whether the additional data needed to compute ICU scores improves mortality prediction for critically ill patients compared to the simpler ED scores.
Methods: We have done a prospective observational study of consecutively admitted 400 critically ill patients to ICU directly from Emergency Department in Dr PSIMS and RF over a period of 2 years. Clinical and laboratory data conforming to the modified early warning score (MEWS), rapid emergency medicine score (REMS), acute physiology and chronic health evaluation (APACHE II), and simplified acute physiology score (SAPS II) were recorded for all patients. A comparison was made between ED scoring systems MEWS, REMS and ICU scoring systems APACHE II, SAPSII. The outcome was recorded in two categories: survived and non-survived with a primary end point of 30-day mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.
Results: The ICU scores outperformed the ED scores with more area under curve values. The predicted mortality percentage of ICU based scoring systems is high compared to emergency scores (predicted mortality % of SAPS II-63%, APACHE II-33.3%, MEWS-18.5%, REMS-14.8%).
Conclusions: ICU scores showed more predictive accuracy than ED scores in prognosticating the outcomes in critically ill patients. This difference is seemed more due to complexity of ICU scores.
References
Gullo, Lumb. Intensive and critical care medicine reflections, recommendations and perspectives (WFSICCM); Springer publications; 2009.
Rao MH, Marella P. Assessment of severity and outcome of critical illness. Indian J Anaesth. 2008;52(5):652-62.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
Norris C, Jacobs P, Rapoport J. ICU and non-ICU cost per day. Can J Anaest. 1995;42:192-96.
Beck DH, Taylor BL, Millar B. Prediction of outcome from intensive care: A prospective cohort study comparing acute physiology and chronic health evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med. 1997;25:9-15.
Rincon T, Welcher B, Srikanth D, Seiver A. Economic implications of data collection from a remote center utilizing technological tools. Crit Care Med. 2007;35(12):A161.
Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10(10):1040-8.
Vasilevskis EE, Kuzniewicz MW, Cason BA. Mortality probability model III and simplified acute physiology score II: assessing their value in predicting length of stay and comparison to APACHE IV. Chest. 2009;136(1):89-101.
Cowen JS, Kelly MA. Errors and bias in using predictive scoring systems. Criti care clin. 1994;10:53-72.
Antman EM, Cohen M, Bernink PJ. The risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284;835-42.
Fiorelli M, Alperovitch A, Argentino C. Prediction of outcome in early hours following acute ischemic stroke. Arch neurol. 1995;52:250-5.
Rodrigo G, Rodrigo C. A new index for early prediction of hospitalization in patients with acute asthma. Am J Emerg Med. 1997;15(1);8-13.
Bouch C, Thompson J. Severity scoring systems in the critically ill. Continuing Education in Anaesthesia. Crit Care Pain. 2008;8(5):181-5.
