OPEN IN READ APP
COMPARATIVE STUDY
JOURNAL ARTICLE

A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in intensive care unit trauma patients

D T Wong, P M Barrow, M Gomez, G P McGuire
Critical Care Medicine 1996, 24 (10): 1642-8
8874299

OBJECTIVE: To assess the ability of the Acute Physiology and Chronic Health Evaluation (APACHE II) system and Trauma-Injury Severity Scoring (TRISS) system in predicting group mortality in intensive care unit (ICU) trauma patients.

DESIGN: Prospective study.

SETTING: A Canadian adult trauma tertiary referral hospital.

PATIENTS: Consecutive trauma patients admitted to the medical-surgical ICU or the neurosurgical ICU.

INTERVENTION: None.

MEASUREMENTS AND MAIN RESULTS: For each patient, demographic data, mechanism of injury, and surgical status were collected. Revised Trauma Scores and Injury Severity Scores were calculated from emergency room and operative data. The APACHE II score was calculated based on the data from the first 24 hrs of ICU admission. The probability of death was calculated for each patient based on the APACHE II and TRISS equations. The ability to predict group mortality for APACHE II and TRISS was assessed by receiver operating characteristic curve analysis, two by two decision matrices, and calibration curve analysis. Four hundred seventy trauma patients were admitted to the ICU. Sixty-three (13%) patients died and 407 (87%) survived. There were significant differences between survivors and nonsurvivors in age, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, and APACHE II score. By receiver operating characteristic curve analysis, the areas under the curves (+/- SEM) of APACHE II and TRISS were 0.92 +/- 0.02 and 0.89 +/- 0.02, respectively. Using two by two decision matrices with a decision criterion of 0.5, the sensitivities, specificities, and percentages correctly classified were 50.8%, 97.3%, and 91.1%, respectively, for APACHE II, and 50.8%, 97.1%, and 90.9%, respectively, for TRISS. From the calibration curves, the r2 value was .93 (p = .0001) for APACHE II and .67 (p = .004) for TRISS.

CONCLUSIONS: Both APACHE II and TRISS scores were shown to accurately predict group mortality in ICU trauma patients. APACHE II and TRISS may be utilized for quality assurance in ICU trauma patients. However, neither APACHE II nor TRISS provides sufficient confidence for prediction of outcome of individual patients.

Comments

You need to log in or sign up for an account to be able to comment.

No comments yet, be the first to post one!

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
8874299
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"