An initial comparison of intensive care in Japan and the United States

Sirio, Carl A.; Tajimi, Kimitaka; Tase, Choichiro; Knaus, William A.; Wagner, Douglas P.; Hirasawa, Hiroyuki; Sakanishi, Nobue; Hikita, Katsuya; Taenaka, Nobuyuki

doi:10.1097/00003246-199209000-00006

Cited by 101 publications

(47 citation statements)

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“…6,[7][8][9][10][11] There was a higher frequency of trauma (15%) in relation to American and European studies, but this was similar to what has already been found in Brazil, 7,10,12 The patient distribution in the APACHE II score intervals showed highest concentrations in the intermediate ranges, coinciding with what was found by other authors. 8,10,13 However, the percentage of patients with APACHE II scores of less than 10 (22.4%), and thus with less severe illness conditions, was much lower than for the US study, 56%. 7 The APACHE II average 14,15 was higher than what was recorded in the United States, 7 Europe 6,10 and Japan, 8 similar to what has been found in Brazil 16 and Canada, 13 and lower than what was recorded in Hong Kong.…”

Section: Discussionsupporting

confidence: 78%

“…8,10,13 However, the percentage of patients with APACHE II scores of less than 10 (22.4%), and thus with less severe illness conditions, was much lower than for the US study, 56%. 7 The APACHE II average 14,15 was higher than what was recorded in the United States, 7 Europe 6,10 and Japan, 8 similar to what has been found in Brazil 16 and Canada, 13 and lower than what was recorded in Hong Kong. 14 There was a meaningful connection between APACHE II scores and the mortality rate, for all the patients and for each diagnostic group.…”

Section: Discussionmentioning

confidence: 69%

“…The ability of this gradational system to predict mortality rates for different patient groups has been assessed in several countries. 8,9,[12][13][14][17][18][19] The following items have been used for assessing the predictive capability of the APACHE II index: receiver operating characteristic curve, 2 x 2 decision matrix, and linear regression analysis (calibration curve).…”

mentioning

confidence: 99%

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Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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CONTEXT: The high-complexity features of intensive care unit services and the clinical situation of patients themselves render correct prognosis fundamentally important not only for patients, their families and physicians, but also for hospital administrators, fund-providers and controllers. Prognostic indices have been developed for estimating hospital mortality rates for hospitalized patients, based on demographic, physiological and clinical data. OBJECTIVE: The APACHE II system was applied within an intensive care unit to evaluate its ability to predict patient outcome; to compare illness severity with outcomes for clinical and surgical patients; and to compare the recorded result with the predicted death rate. DESIGN: Diagnostic test. SETTING: Clinical and surgical intensive care unit in a tertiary-care teaching hospital. PARTICIPANTS: The study involved 521 consecutive patients admitted to the intensive care unit from July 1998 to June 1999. MAIN MEASUREMENTS: APACHE II score, in-hospital mortality, receiver operating characteristic curve, decision matrices and linear regression analysis. RESULTS: The patients' mean age was 50 ± 19 years and the APACHE II score was 16.7 ± 7.3. There were 166 clinical patients (32%), 173 (33%) post-elective surgery patients (33%), and 182 post-emergency surgery patients (35%), thus producing statistically similar proportions. The APACHE II scores for clinical patients (18.5 ± 7.8) were similar to those for non-elective surgery patients (18.6 ± 6.5) and both were greater than for elective surgery patients (13.0 ± 6.3) (p < 0.05). The higher this score was, the higher the mortality rate was (p < 0.05). The predicted death rate was 25.6% and the recorded death rate was 35.5%. Through the use of receiver operating curve analysis, good discrimination was found (area under the curve = 0.80). From the 2 x 2 decision matrix, 72.2% of patients were correctly classified (sensitivity = 35.1%; specificity = 92.6%). Linear regression analysis was equivalent to r² = 0.92. CONCLUSIONS: APACHE II was useful for stratifying these patients. The illness severity and death rate among clinical patients were higher than those recorded for surgical patients. Despite the stratification ability of the APACHE II system, it lacked accuracy in predicting death rates. The recorded death rate was higher than the predicted rate.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 69%

mentioning

confidence: 99%

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Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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“…These models should include: 1) variables that reflect out-of-hospital severity of illness assessment and therapy; 2) use of practical time-indexed variables that reflect response to treatment delivered in the dynamic resuscitations that frequently occur during ED care such as lactate, 39 base deficit, 40 central venous oxygen saturation, 41 shock index, 41 and noninvasive measurement of systemic oxygen delivery and consumption 42,43 ; 3) the creation of an independent multicenter database to establish adequate sample size and power 14,[44][45][46][47][48] ; 4) the analysis of the relationships among the predictive variables and actual patient outcome for both overall calibration of outcome estimates and ability to discriminate survivors from nonsurvivors; and 5) the establishment of other outcomes than death such as length of ICU stay, length of mechanical ventilation, and functional status at hospital discharge. 22 Outcome prediction science is not considered synonymous with physician clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Nguyen

Rivers

Havstad

et al. 2000

Academic Emergency Medicine

151

102

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Abstract. Objectives:The changing landscape of health care in this country has seen an increase in the delivery of care to critically ill patients in the emergency department (ED). However, methodologies to assess care and outcomes similar to those used in the intensive care unit (ICU) are currently lacking in this setting. This study examined the impact of ED intervention on morbidity and mortality using the Acute Physiology and Chronic Health Evaluation (APACHE II), the Simplified Acute Physiology Score (SAPS II), and the Multiple Organ Dysfunction Score (MODS). Methods: This was a prospective, observational cohort study over a three-month period. Critically ill adult patients presenting to a large urban ED and requiring ICU admission were enrolled. APACHE II, SAPS II, and MODS scores and predicted mortality were obtained at ED admission, ED discharge, and 24, 48, and 72 hours in the ICU. In-hospital mortality was recorded. Results: Eighty-one patients aged 64 Ϯ 18 years were enrolled during the study period, with a 30.9% in-hospital mortality. The ED length of stay was 5.9 Ϯ 2.7 hours and the hospital length of stay was 12.2 Ϯ 16.6 days. Nine (11.1%) patients initially accepted for ICU admission were later admitted to the general ward after ED intervention. Septic shock was the predominant admitting diagnosis. At ED admission, there was a significantly higher APACHE II score in nonsurvivors (23.0 Ϯ 6.0) vs survivors (19.8 Ϯ 6.5, p = 0.04), while there was no significant difference in SAPS II or MODS scores. The APACHE II, SAPS II, and MODS scores were significantly lower in survivors than nonsurvivors throughout the hospital stay (p Յ 0.001). The hourly rates of change (decreases) in APACHE II, SAPS II, and MODS scores were significantly greater during the ED stay (Ϫ0.55 Ϯ 0.64, Ϫ1.02 Ϯ 1.10, and Ϫ0.16 Ϯ 0.43, respectively) than subsequent periods of hospitalization in survivors (p < 0.05). There was a significant decrease in APACHE II and SAPS II predicted mortality during the ED stay (Ϫ8.0 Ϯ 14.0% and Ϫ6.0 Ϯ 14.0%, respectively, p < 0.001) and equally at 24 hours in the ICU (Ϫ7.0 Ϯ 13.0% and Ϫ4.0 Ϯ 16.0%, respectively, p Յ 0.02). The APACHE II and SAPS II predicted mortality approached actual in-hospital mortality at approximately 12 hours and 36 hours after ED admission (in the ICU), respectively. Conclusions: The care provided during the ED stay for critically ill patients significantly impacts the progression of organ failure and mortality. Although this period is brief compared with the total length of hospitalization, physiologic determinants of outcome may be established before ICU admission. This study emphasizes the importance of ED intervention. It also suggests that unique physiologic assessment methodologies should be developed to examine the quality of patient care, improve the accuracy of prognostic decisions, and objectively measure the impact of clinical interventions and pathways in the ED setting.

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“…[15][16][17][18] Our objective was to determine, in a large number of patients, if echocardiographic data would add prognostication to existing clinical variables in MSICU patients. This clinical study attempts to associate specific cardiovascular pathology identified utilizing TTE with mortality in the MSICU.…”

Section: Objectifmentioning

confidence: 99%

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

Sawchuk

Wong

Kavanagh

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the hypothesis that transthoracic echocardiographic findings predict mortality in critically ill patients.M Me et th ho od ds s: : A retrospective analysis of concurrently collected data for consecutive patients from May 1996 to May 1998 who had transthoracic echocardiography on or within six months of admission to the medical surgical intensive care (MSICU). We examined the role of physiologic, clinical, and echocardiography variables in predicting the mortality of patients admitted to the MSICU. Three logistic regression models were developed: 1) clinical; 2) echocardiographic; and 3) combined clinical with echocardiographic. Univariate and multivariate analyses were performed and the relative strength of clinical and echocardiographic predictors was compared using odds ratio (OR) and receiver-operator-characteristic (ROC).

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An initial comparison of intensive care in Japan and the United States

Cited by 101 publications

References 0 publications

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

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