Evaluation of APACHE II for Cost Containment and Quality Assurance

Abstract

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.

Comparison of Sepsis-related Organ Failure Assessment (SOFA) score and CIS (cellular injury score) for scoring of severity for patients with multiple organ dysfunction syndrome (MODS)

“…Furthermore, they are difficult to use on a daily basis. In addition, it has been reported that APACHE II does not always reflect the severity of MODS in patients belonging to certain groups [21,22,23]. In fact, Civetta et al [21] found that neither the length of stay in the ICU nor mortality correlated with APACHE II for surgical ICU patients.…”

“…In addition, it has been reported that APACHE II does not always reflect the severity of MODS in patients belonging to certain groups [21,22,23]. In fact, Civetta et al [21] found that neither the length of stay in the ICU nor mortality correlated with APACHE II for surgical ICU patients. Similarly, Cerra et al [23] reported that APACHE II did not always predict manifestations of MOF and mortality; they noted, instead, that changes over time in four parameters, PaO 2 /FIO 2 ratio, creatinine, bilirubin and lactate (the latter two not included in APACHE II) were more useful in predicting death.…”

Prognostic Scoring Indicator in Evaluation of Clinical Outcome In Intestinal Perforations

“…Grading the severity of acute peritonitis has assisted in decision making and has made therapy ameliorated for the management of severely ill patients [4]. The assessment of risk considering various clinical parameters to evaluate new therapies, monitor resource utilization, quality of care improvement is of immense value at present [5,6]. It is very difficult to evaluate severity, decide treatment options, therapeutic approach for the acute generalized peritonitis caused due to perforation due to its broad overlapping classification.…”

Study of Predictive Ability of Modified Apache Ii Score to Prognosticate the Outcome and Severity of Generalized Peritonitis Secondary to Typhoid Ileal Perforation

“…[4] The assessment of risk considering various clinical parameters to evaluate new therapies, monitor resource utilization, quality of care improvement is of immense value at present. [5,6] Many scoring systems are available that helps to measure & stratify the condition of critically ill patients and thus helps the clinicians in better resource allocation as per the needs of the patient and feasibility of outcome expected. [7] Amongst them APACHE II (Acute Physiological and Chronic ill Health Evaluation), is widely used.…”